AJDRAJNR - American Journal of Neuroradiology

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bartynski, W.S.
Right arrow Articles by Boardman, J.F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bartynski, W.S.
Right arrow Articles by Boardman, J.F.

BRAIN

Distinct Imaging Patterns and Lesion Distribution in Posterior Reversible Encephalopathy Syndrome

W.S. Bartynskia and J.F. Boardmana

a From the Department of Radiology, Division of Neuroradiology, Presbyterian University Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pa

Address correspondence to Walter S. Bartynski, MD, Department of Radiology, Division of Neuroradiology, Presbyterian University Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, D132, Pittsburgh, PA 15213; e-mail: bartynskiws{at}upmc.edu

BACKGROUND AND PURPOSE: Although the term posterior reversible encephalopathy syndrome (PRES) was popularized because of the typical presence of vasogenic edema in the parietal and occipital lobes, other regions of the brain are also frequently affected. We evaluated lesion distribution with CT and MR in a large cohort of patients who experienced PRES to comprehensively assess the imaging patterns identified.

MATERIALS AND METHODS: The locations of the PRES lesion at toxicity were comprehensively identified and tabulated in 136 patients by CT (22 patients) and MR (114 patients) imaging including the hemispheric, basal ganglial, and infratentorial locations. Clinical associations along with presentation at toxicity including blood pressure were assessed.

RESULTS: Vasogenic edema was consistently present in the parietal or occipital regions (98%), but other locations were common including the frontal lobes (68%), inferior temporal lobes (40%), and cerebellar hemispheres (30%). Involvement of the basal ganglia (14%), brain stem (13%), and deep white matter (18%) including the splenium (10%) was not rare. Three major patterns of PRES were noted: the holohemispheric watershed (23%), superior frontal sulcal (27%), and dominant parietal-occipital (22%), with additional common partial or asymmetric expression of these primary PRES patterns (28%).

CONCLUSION: Involvement of the frontal lobe, temporal lobe, and cerebellar hemispheres is common in PRES, along with the occasional presence of lesions in the brain stem, basal ganglia, deep white matter, and splenium. Three primary PRES patterns are noted in the cerebral hemispheres, along with frequent partial or asymmetric expression of these PRES patterns. Awareness of these patterns and variations is important to recognize PRES neurotoxicity more accurately when present.




This article has been cited by other articles:


Home page
Ann. Thorac. Surg.Home page
E. F.M. Wijdicks, N. Campeau, and T. Sundt
Reversible unilateral brain edema presenting with major neurologic deficit after valve repair.
Ann. Thorac. Surg., August 1, 2008; 86(2): 634 - 637.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
W.S. Bartynski
Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features
AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1036 - 1042.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
W.S. Bartynski
Posterior Reversible Encephalopathy Syndrome, Part 2: Controversies Surrounding Pathophysiology of Vasogenic Edema
AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1043 - 1049.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
W.S. Bartynski, H.P. Tan, J.F. Boardman, R. Shapiro, and J.W. Marsh
Posterior Reversible Encephalopathy Syndrome after Solid Organ Transplantation
AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 924 - 930.
[Abstract] [Full Text] [PDF]


Home page
J. Neurol. Neurosurg. PsychiatryHome page
C A Davie and P O'Brien
Stroke and pregnancy
J. Neurol. Neurosurg. Psychiatry, March 1, 2008; 79(3): 240 - 245.
[Abstract] [Full Text] [PDF]