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Case 13
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Yes, they are as follows:StrokeSeizuresPosterior reversible encephalopathy syndrome (PRES)Neuropsychiatric changesCranial nerve alterationsHeadacheEye/visual changesPeripheral neuropathy
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Posterior reversible encephalopathy syndrome (PRES) can be caused by a variety of insults, one of which is hypertension. The distribution is variable and can include more anterior structures such as the watershed zones, inferior temporal and posterior frontal lobes but it is classically described as occipitoparietal. There is T2 hyperintensity and T1 hypointensity in the affected regions due to oedema which manifests as hypodensity on CT. Given the right clinical history one differential diagnosis is a posterior circulation stroke. Microhaemorrhage can be a feature in both diagnoses; however, whereas an acute stroke would lead to restricted diffusion, this finding is not typical in PRES and can be a helpful distinguishing factor.
Oncological effects on the central nervous system
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Posterior reversible encephalopathy syndrome (PRES) was first described in 1996 under the name ‘reversible posterior leukoencephalopathy’. These first cases all had acute neurological symptoms, often seizures, and showed distinctive subcortical vasogenic white matter oedema in the parieto-occipital regions of the brain (11). Since the initial description, the syndrome has been much more widely recognized, in part due to the increased use of neuroimaging. The syndrome can be associated with the use of a wide range of chemotherapeutic and immunosuppressive drugs, as well as being associated with hypertensive episodes, renal dysfunction, sepsis, transplantation, and pre-eclampsia. Patients with leukaemia and lymphoma are particularly at risk as well as those with bone marrow transplants and solid organ transplants (12). The more commonly associated agents include tacrolimus and a number of anti–vascular endothelial growth factor (VEGF) agents (e.g. bevacizumab, sunitinib, vandetanib, axitinib) (13). Chemotherapeutic agents such as cytarabine, cisplatin, and gemcitabine are also recognized associations (14).
Postpartum intracranial hypotension complicated by posterior reversible encephalopathy syndrome: a case report
Published in International Journal of Neuroscience, 2020
Maria Chondrogiorgi, Anastasia K Zikou, Spiridon Konitsiotis, Sofia Markoula
Posterior reversible encephalopathy syndrome (PRES) is a disorder of subacute onset most commonly associated with acute hypertension, renal disease, sepsis and exposure to immunosuppressants, as well as (pre)eclampsia [2–4]. After its initial description by Hinchey et al in 1996 [5] and the increasing use of brain MRI in the past two decades the syndrome has been reported across all ages starting from early childhood but with a higher frequency in young and middle-aged adults and a highly consistent female preponderance [6,7]. However, since PRES is still considered a highly under-recognized condition and most of the available data come from case-series and retrospective observational studies the epidemiological data are scarce and the exact incidence of the syndrome is unknown [2,8]. The clinical manifestations of PRES, which are usually transient, include headache, visual changes, encephalopathy and seizures. Intracranial hypotension is not a commonly known precipitant of PRES, however a limited number of previous reports have proposed a possible association between intracranial hypotension caused by cerebrospinal fluid (CSF) leak and PRES [9–14].
Isolated brainstem involvement in posterior reversible encephalopathy syndrome: a case report and review of the literature
Published in International Journal of Neuroscience, 2019
Chenchen Liu, Jie Cao, Zhuyi Su, Shabei Xu
Posterior reversible encephalopathy syndrome (PRES) is a disorder characterized by acute neurological symptoms, such as headache, vomiting, visual disturbances, seizures, confusion and focal neurological signs. Neuroimaging usually reveals reversible vasogenic edema predominantly involving the white matter of both cerebral hemispheres, especially parieto-occipital regions [1]. Brain edema affecting regions other than typical parieto-occipital regions is not uncommon, including frontal and temporal lobes, basal ganglia, cerebellum and brainstem [2]. However, those unusual lesions are always accompanied by involvement of parieto-occipital regions, isolated brainstem involvement in PRES (IBPRES) has been rarely reported. Little is known about its clinical manifestations, radiological features and outcomes. The aim of this study was to perform a systematic review of published cases on IBPRES.
Ophthalmic Manifestations of Posterior Reversible Encephalopathy Syndrome
Published in Neuro-Ophthalmology, 2019
Nicole Lifson, Andrew Pasquale, George Salloum, Samuel Alpert
Posterior reversible encephalopathy syndrome (PRES) is a syndrome of neurotoxicity that typically involves headaches, confusion, seizures, and occasionally, loss of vision. Neuroimaging is one of the most important diagnostic features of the disease and typically indicates vasogenic oedema localized to the posterior occipital and parietal lobes, but other areas of the brain can be affected.1 There is little consensus on the pathophysiology of PRES, but it is suspected to be related either to inadequate cerebral autoregulation or endothelial dysfunction. This causes cerebral hyperperfusion, which eventually leads to extravasation of fluid and blood in the posterior aspect of the brain.1 PRES has been diagnosed in ages ranging from 4 to 90, with the diagnosis more commonly made in middle-aged adults, with the average age between 39 and 47 years.2 Many patients diagnosed with PRES have comorbid conditions including hypertension, vascular and autoimmune diseases, eclampsia, organ transplant, immunosuppressive therapy, and chronic renal disease.1