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Brain
Diagnosis
Pathology-Based Diagnoses
Acquired Toxic/Metabolic/Degenerative Disorders
Toxic, Metabolic, Nutritional, Systemic Diseases With CNS Manifestations
Acute Hypertensive Encephalopathy, PRES
Acute Hypertensive Encephalopathy, PRES
Miral D. Jhaveri, MD, MBA; Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Posterior reversible encephalopathy syndrome (PRES)

            • Synonyms

              • Acute hypertensive encephalopathy
              • Reversible posterior leukoencephalopathy syndrome (RPLS)

            • Definitions

              • Variant of acute hypertensive encephalopathy characterized by headache, visual disturbances, altered mental function
              • Cerebrovascular autoregulatory disorder
                • Multiple etiologies; most caused by acute HTN

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Liman TG et al: Posterior reversible encephalopathy syndrome. Curr Opin Neurol. 32(1):25-35, 2019
                                          2. Racchiusa S et al: Posterior reversible encephalopathy syndrome (PRES) and infection: a systematic review of the literature. Neurol Sci. 40(5):915-22, 2019
                                          3. Tetsuka S et al: Posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics. J Neurol Sci. 404:72-9, 2019
                                          4. Brady E et al: The imaging spectrum of posterior reversible encephalopathy syndrome: a pictorial review. Clin Imaging. 47:80-9, 2018
                                          5. Fischer M et al: Posterior reversible encephalopathy syndrome. J Neurol. 264(8):1608-16, 2017
                                          6. Pereira PR et al: Clinical, imagiological and etiological spectrum of posterior reversible encephalopathy syndrome. Arq Neuropsiquiatr. 73(1):36-40, 2015
                                          7. Thompson RJ et al: Posterior reversible encephalopathy syndrome in the emergency department: case series and literature review. West J Emerg Med. 16(1):5-10, 2015
                                          8. Gao B et al: Central-variant posterior reversible encephalopathy syndrome: more than meets the eye. AJR Am J Roentgenol. 203(4):W454, 2014
                                          9. Junewar V et al: Neuroimaging features and predictors of outcome in eclamptic encephalopathy: a prospective observational study. AJNR Am J Neuroradiol. 35(9):1728-34, 2014
                                          10. Lamy C et al: Posterior reversible encephalopathy syndrome. Handb Clin Neurol. 121:1687-701, 2014
                                          11. Rykken JB et al: Posterior reversible encephalopathy syndrome. Semin Ultrasound CT MR. 35(2):118-35, 2014
                                          12. Brewer J et al: Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 208(6):468, 2013
                                          13. Khosravani H et al: Emergency noninvasive angiography for acute intracerebral hemorrhage. AJNR Am J Neuroradiol. 34(8):1481-7, 2013
                                          14. Li R et al: Is hypertension predictive of clinical recurrence in posterior reversible encephalopathy syndrome? J Clin Neurosci. 20(2):248-52, 2013
                                          15. McKinney AM et al: Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol. 33(5):896-903, 2012
                                          16. Peter P et al: Posterior reversible encephalopathy syndrome and the pediatric population. J Pediatr Neurosci. 7(2):136-8, 2012
                                          17. McCoy B et al: Childhood posterior reversible encephalopathy syndrome. Eur J Paediatr Neurol. 15(2):91-4, 2011
                                          18. Hefzy HM et al: Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol. 30(7):1371-9, 2009
                                          19. Bartynski WS: Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 29(6):1036-42, 2008
                                          20. Bartynski WS: Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 29(6):1043-9, 2008
                                          21. Bartynski WS et al: Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 27(10):2179-90, 2006
                                          22. Ishikura K et al: Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings. Am J Kidney Dis. 48(2):231-8, 2006
                                          23. Mirza A: Posterior reversible encephalopathy syndrome: a variant of hypertensive encephalopathy. J Clin Neurosci. 13(5):590-5, 2006
                                          24. Narbone MC et al: PRES: posterior or potentially reversible encephalopathy syndrome? Neurol Sci. 27(3):187-9, 2006
                                          25. Pande AR et al: Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study. Radiat Med. 24(10):659-68, 2006
                                          26. Kaito E et al: The role of tumor lysis in reversible posterior leukoencephalopathy syndrome. Pediatr Radiol. 35(7):722-7, 2005
                                          27. Striano P et al: Clinical spectrum and critical care management of posterior reversible encephalopathy syndrome (PRES). Med Sci Monit. 11(11):CR549-53, 2005
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Posterior reversible encephalopathy syndrome (PRES)

                                                    • Synonyms

                                                      • Acute hypertensive encephalopathy
                                                      • Reversible posterior leukoencephalopathy syndrome (RPLS)

                                                    • Definitions

                                                      • Variant of acute hypertensive encephalopathy characterized by headache, visual disturbances, altered mental function
                                                      • Cerebrovascular autoregulatory disorder
                                                        • Multiple etiologies; most caused by acute HTN

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Liman TG et al: Posterior reversible encephalopathy syndrome. Curr Opin Neurol. 32(1):25-35, 2019
                                                                                  2. Racchiusa S et al: Posterior reversible encephalopathy syndrome (PRES) and infection: a systematic review of the literature. Neurol Sci. 40(5):915-22, 2019
                                                                                  3. Tetsuka S et al: Posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics. J Neurol Sci. 404:72-9, 2019
                                                                                  4. Brady E et al: The imaging spectrum of posterior reversible encephalopathy syndrome: a pictorial review. Clin Imaging. 47:80-9, 2018
                                                                                  5. Fischer M et al: Posterior reversible encephalopathy syndrome. J Neurol. 264(8):1608-16, 2017
                                                                                  6. Pereira PR et al: Clinical, imagiological and etiological spectrum of posterior reversible encephalopathy syndrome. Arq Neuropsiquiatr. 73(1):36-40, 2015
                                                                                  7. Thompson RJ et al: Posterior reversible encephalopathy syndrome in the emergency department: case series and literature review. West J Emerg Med. 16(1):5-10, 2015
                                                                                  8. Gao B et al: Central-variant posterior reversible encephalopathy syndrome: more than meets the eye. AJR Am J Roentgenol. 203(4):W454, 2014
                                                                                  9. Junewar V et al: Neuroimaging features and predictors of outcome in eclamptic encephalopathy: a prospective observational study. AJNR Am J Neuroradiol. 35(9):1728-34, 2014
                                                                                  10. Lamy C et al: Posterior reversible encephalopathy syndrome. Handb Clin Neurol. 121:1687-701, 2014
                                                                                  11. Rykken JB et al: Posterior reversible encephalopathy syndrome. Semin Ultrasound CT MR. 35(2):118-35, 2014
                                                                                  12. Brewer J et al: Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 208(6):468, 2013
                                                                                  13. Khosravani H et al: Emergency noninvasive angiography for acute intracerebral hemorrhage. AJNR Am J Neuroradiol. 34(8):1481-7, 2013
                                                                                  14. Li R et al: Is hypertension predictive of clinical recurrence in posterior reversible encephalopathy syndrome? J Clin Neurosci. 20(2):248-52, 2013
                                                                                  15. McKinney AM et al: Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol. 33(5):896-903, 2012
                                                                                  16. Peter P et al: Posterior reversible encephalopathy syndrome and the pediatric population. J Pediatr Neurosci. 7(2):136-8, 2012
                                                                                  17. McCoy B et al: Childhood posterior reversible encephalopathy syndrome. Eur J Paediatr Neurol. 15(2):91-4, 2011
                                                                                  18. Hefzy HM et al: Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol. 30(7):1371-9, 2009
                                                                                  19. Bartynski WS: Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 29(6):1036-42, 2008
                                                                                  20. Bartynski WS: Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 29(6):1043-9, 2008
                                                                                  21. Bartynski WS et al: Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 27(10):2179-90, 2006
                                                                                  22. Ishikura K et al: Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings. Am J Kidney Dis. 48(2):231-8, 2006
                                                                                  23. Mirza A: Posterior reversible encephalopathy syndrome: a variant of hypertensive encephalopathy. J Clin Neurosci. 13(5):590-5, 2006
                                                                                  24. Narbone MC et al: PRES: posterior or potentially reversible encephalopathy syndrome? Neurol Sci. 27(3):187-9, 2006
                                                                                  25. Pande AR et al: Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study. Radiat Med. 24(10):659-68, 2006
                                                                                  26. Kaito E et al: The role of tumor lysis in reversible posterior leukoencephalopathy syndrome. Pediatr Radiol. 35(7):722-7, 2005
                                                                                  27. Striano P et al: Clinical spectrum and critical care management of posterior reversible encephalopathy syndrome (PRES). Med Sci Monit. 11(11):CR549-53, 2005