American Journal of Neuroradiology 21:1199-1206 (7 2000)
© 2000 American Society of Neuroradiology
ARTICLE
Posterior Reversible Encephalopathy Syndrome: Utility of Fluid-attenuated Inversion Recovery MR Imaging in the Detection of Cortical and Subcortical Lesions
a From the Department of Radiology, University of Minnesota Medical School, Minneapolis, MN.
BACKGROUND AND PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is typically characterized by headache, altered mental functioning, seizures, and visual loss associated with imaging findings of bilateral subcortical and cortical edema with a predominantly posterior distribution. Our goal was to determine whether fluid-attenuated inversion recovery (FLAIR) imaging improves the ability to detect subtle peripheral lesions of PRES, as compared with conventional MR techniques.
METHODS: Sixteen patients with clinical and imaging findings consistent with PRES were studied. Thirteen patients had undergone transplantation and had cyclosporin A neurotoxicity. Fast-FLAIR images were compared with spin-echo proton density–and T2-weighted images.
RESULTS: FLAIR imaging improved diagnostic confidence and conspicuity of the T2 hyperintense lesions of PRES, typically in the subcortical white matter of the parietooccipital regions bilaterally. On all 23 abnormal MR studies, FLAIR was judged superior to proton density–and T2-weighted images for the detection of PRES in the supratentorial brain. In a mean of 6.7 of 23 studies, FLAIR findings prompted a raise in the grade of disease severity. FLAIR also showed cortical involvement in 94% of patients with PRES and in a mean of 46% of the total lesion burden. In four cases, subtle lesions were virtually undetectable without FLAIR. Brain stem or cerebellar disease was encountered in 56% of patients.
CONCLUSION: FLAIR improves the ability to diagnose and detect subcortical and cortical lesions in PRES as compared with proton density–and T2-weighted spin-echo images. We therefore believe that FLAIR should be performed in patients with suspected PRES to allow more confident recognition of the often subtle imaging abnormalities.
This article has been cited by other articles:
 |
|
 |
|
  S. Salloway, R. Sperling, S. Gilman, N. C. Fox, K. Blennow, M. Raskind, M. Sabbagh, L. S. Honig, R. Doody, C. H. van Dyck, et al. A phase 2 multiple ascending dose trial of bapineuzumab in mild to moderate Alzheimer disease Neurology, December 15, 2009; 73(24): 2061 - 2070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ito, B. G. Weinshenker, S. M. Magana, M. Matiello, and A. A. Rabinstein POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN NEUROMYELITIS OPTICA SPECTRUM DISORDERS Neurology, November 10, 2009; 73(19): 1604 - 1605. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Morelle, G. Cosnard, M. Jadoul, and N. Kanaan Transient blindness and seizures in severe lupus nephritis NDT Plus, August 1, 2009; 2(4): 331 - 332. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. McKinney, S. A. Kieffer, R. T. Paylor, K. S. SantaCruz, A. Kendi, and L. Lucato Acute Toxic Leukoencephalopathy: Potential for Reversibility Clinically and on MRI With Diffusion-Weighted and FLAIR Imaging Am. J. Roentgenol., July 1, 2009; 193(1): 192 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Mehta, T Khan, T F Ismail, A Rogers, A Wallis, D Collas, W R J Wallis, M J van der Watt, and D J Werring Headache, blindness and a seizure after childbirth Postgrad. Med. J., October 1, 2008; 84(996): 555 - 557. [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Hollingsworth, D. P. Frush, J. Kurtzburg, and V. K. Prasad Pediatric Hematopoietic Stem Cell Transplantation and the Role of Imaging Radiology, August 1, 2008; 248(2): 348 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Leroux, J. Sellam, N. Costedoat-Chalumeau, D. Le Thi Huong, A. Combes, N. Tieulie, J. Haroche, Z. Amoura, A. Nieszkowska, J. Chastre, et al. Posterior reversible encephalopathy syndrome during systemic lupus erythematosus: four new cases and review of the literature Lupus, February 1, 2008; 17(2): 139 - 147. [Abstract] [PDF]
|
|
|
|
 |
|
 K. El Karoui, M. Le Quintrec, E. Dekeyser, A. Servais, A. Hummel, F. Fadel, and F. Fakhouri Posterior reversible encephalopathy syndrome in systemic lupus erythematosus Nephrol. Dial. Transplant., February 1, 2008; 23(2): 757 - 763. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Hinchey Reversible Posterior Leukoencephalopathy Syndrome: What Have We Learned in the Last 10 Years? Arch Neurol, February 1, 2008; 65(2): 175 - 176. [Full Text] [PDF]
|
|
|
|
|
|
V. H. Lee, E. F. M. Wijdicks, E. M. Manno, and A. A. Rabinstein Clinical Spectrum of Reversible Posterior Leukoencephalopathy Syndrome Arch Neurol, February 1, 2008; 65(2): 205 - 210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Sinha and R M Hurley Posterior reversible encephalopathy syndrome in SLE nephritis Postgrad. Med. J., January 1, 2008; 84(987): 56 - 56. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rajasekhar and T. J. George Jr. Gemcitabine-Induced Reversible Posterior Leukoencephalopathy Syndrome: A Case Report and Review of the Literature Oncologist, November 1, 2007; 12(11): 1332 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. McKinney, J. Short, C. L. Truwit, Z. J. McKinney, O. S. Kozak, K. S. SantaCruz, and M. Teksam Posterior Reversible Encephalopathy Syndrome: Incidence of Atypical Regions of Involvement and Imaging Findings Am. J. Roentgenol., October 1, 2007; 189(4): 904 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-M. Ho and K.-H. Chan Posterior Reversible Encephalopathy Syndrome with Vasospasm in a Postpartum Woman After Postdural Puncture Headache Following Spinal Anesthesia Anesth. Analg., September 1, 2007; 105(3): 770 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.L. Ishimori, B.D. Pressman, D.J. Wallace, and M.H. Weisman Posterior reversible encephalopathy syndrome: another manifestation of CNS SLE? Lupus, June 1, 2007; 16(6): 436 - 443. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Natsume, A. Sofue, A. Yamada, and K. Kato Electroencephalographic (EEG) Findings in Posterior Reversible Encephalopathy Associated With Immunosuppressants J Child Neurol, July 1, 2006; 21(7): 620 - 623. [Abstract] [PDF]
|
|
|
|
|
|
S. Heiss, W. Krampla, and R. Klauser-Braun A patient recently transplanted with a living donor kidney develops severe neurological symptoms Nephrol. Dial. Transplant., July 1, 2006; 21(7): 2017 - 2019. [Full Text] [PDF]
|
|
|
|
|
|
A. Aeby, P. David, C. Fricx, P. Jissendi, S. Blecic, and P. Van Bogaert Posterior Reversible Encephalopathy Syndrome Revealing Acute Post-Streptococcal Glomerulonephritis J Child Neurol, March 1, 2006; 21(3): 250 - 251. [Abstract] [PDF]
|
|
|
|
 |
|
 N. Besenski, Z. Rumboldt, O. Emovon, J. Nicholas, S. Kini, J. Milutinovic, and M. N. Budisavljevic Brain MR Imaging Abnormalities in Kidney Transplant Recipients AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2282 - 2289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Bratby and D MacVicar Seizures following bone marrow transplantation Br. J. Radiol., June 1, 2005; 78(930): 575 - 577. [Full Text] [PDF]
|
|
|
|
|
|
L. M. Brubaker, J. K. Smith, Y. Z. Lee, W. Lin, and M. Castillo Hemodynamic and Permeability Changes in Posterior Reversible Encephalopathy Syndrome Measured by Dynamic Susceptibility Perfusion-Weighted MR Imaging AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 825 - 830. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Turner, F. Bianco, F. Fattapposta, N. Locuratolo, A. Pierallini, F. Ruberto, M. Rossi, and L. Bozzao Reversible diffusion MRI abnormalities and transient mutism after liver transplantation Neurology, January 11, 2005; 64(1): 177 - 177. [Full Text] [PDF]
|
|
|
|
|
|
F. Bianco, F. Fattapposta, N. Locuratolo, A. Pierallini, M. Rossi, F. Ruberto, and L. Bozzao Reversible diffusion MRI abnormalities and transient mutism after liver transplantation Neurology, March 23, 2004; 62(6): 981 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Saleh, F Wenserski, M Cohnen, G Furst, E Godehardt, and U Modder Exclusion of brain lesions: is MR contrast medium required after a negative fluid-attenuated inversion recovery sequence? Br. J. Radiol., March 1, 2004; 77(915): 183 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Bakker, C. A. Verburgh, M. A. van Buchem, and L. C. Paul Hypertension, cerebral oedema and fundoscopy Nephrol. Dial. Transplant., November 1, 2003; 18(11): 2424 - 2427. [Full Text] [PDF]
|
|
|
|
|
|
J. Finsterer, T. Schlager, W. Kopsa, and E. Wild Nitroglycerin-aggravated pre-eclamptic posterior reversible encephalopathy syndrome (PRES) Neurology, September 9, 2003; 61(5): 715 - 716. [Full Text] [PDF]
|
|
|
|
 |
|
 I M Kiemeneij, F-E de Leeuw, L M P Ramos, and J van Gijn Acute headache as a presenting symptom of tacrolimus encephalopathy J. Neurol. Neurosurg. Psychiatry, August 1, 2003; 74(8): 1126 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S C Keswani and R Wityk Don't throw in the towel! A case of reversible coma J. Neurol. Neurosurg. Psychiatry, July 1, 2002; 73(1): 83 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Covarrubias, P. H. Luetmer, and N. G. Campeau Posterior Reversible Encephalopathy Syndrome: Prognostic Utility of Quantitative Diffusion-Weighted MR Images AJNR Am. J. Neuroradiol., June 1, 2002; 23(6): 1038 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. S. Eichler, P. Wang, R. J. Wityk, N. J. Beauchamp Jr, and P. B. Barker Diffuse Metabolic Abnormalities in Reversible Posterior Leukoencephalopathy Syndrome AJNR Am. J. Neuroradiol., May 1, 2002; 23(5): 833 - 837. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Casey ""T2 Washout"": An Explanation for Normal Diffusion-Weighted Images Despite Abnormal Apparent Diffusion Coefficient Maps AJNR Am. J. Neuroradiol., September 1, 2001; 22(8): 1450 - 1451. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Provenzale, J. R. Petrella, L. C. H. Cruz Jr, J. C. Wong, S. Engelter, and D. P. Barboriak Quantitative Assessment of Diffusion Abnormalities in Posterior Reversible Encephalopathy Syndrome AJNR Am. J. Neuroradiol., September 1, 2001; 22(8): 1455 - 1461. [Abstract] [Full Text] [PDF]
|
|