Neuroimaging features in Posterior Reversible Encephalopathy Syndrome: A Pictorial Review

Morgan Ollivier (1, 2) , Anne Bertrand (3, 4, 1) , Frédéric Clarençon (1) , Sophie Gerber (1) , Sandrine Deltour (1) , Fanny Domont (1, 5, 1) , Stéphanie Trunet (1) , Didier Dormont (4, 1) , Delphine Leclercq (1)

1 CHU Pitié-Salpêtrière [AP-HP]
2 DR - Brest - Département de radiologie [Brest]
3 ARAMIS - Algorithms, models and methods for images and signals of the human brain = Algorithmes, modèles et méthodes pour les images et les signaux du cerveau humain [ICM Paris]
4 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
5 I3 - Immunologie - Immunopathologie - Immunothérapie

Posterior reversible encephalopathy syndrome (PRES) is a radioclinical entity associating nonspecific neurological symptoms (headache, seizures, impairment of alertness, visual disturbances...) occurring in evocative clinical condition (hypertension, eclampsia, immunosuppressor agents, systemic lupus erythematosus...). In the acute stage, the typical imaging finding is a vasogenic edema predominant in the subcortical parietal-occipital white matter. The purpose of this pictorial review is to illustrate the different neuroimaging features of PRES and present key radiological elements to assert diagnosis. In this overview, we examine the following points: the distributions of vasogenic edema, hemorrhage, the varying patterns in diffusion and perfusion, the different types of enhancement encountered and the vascular modifications demonstrated by angiography. The cause of PRES is still unknown. Nevertheless, catheter angiography, MR angiography and MR perfusion features in PRES render further insight into its pathophysiology. Follow-up imaging shows evidence of radiologic improvement in the very large majority of cases in 1 or 2 weeks, sometimes in up to 1 month. Recurrent PRES attacks are uncommon. Atypical imaging presentation should not reject the diagnosis of PRES in a compatible clinical situation.

Mots clés: Arterial Spin-Labeling; Perfusion Imaging,; Posterior Leukoencephalopathy Syndrome; Magnetic Resonance Imaging; Hemorrhage; Diffusion Magnetic Resonance Imaging

Domaines: Organes des sens

Morgan Ollivier, Anne Bertrand, Frédéric Clarençon, Sophie Gerber, Sandrine Deltour, et al.. Neuroimaging features in Posterior Reversible Encephalopathy Syndrome: A Pictorial Review. Journal of the Neurological Sciences, 2016, ⟨10.1016/j.jns.2016.12.007⟩. ⟨hal-01427526⟩