Posterior Reversible Encephalopathy Syndrome: A Clinico-Radiological Approach

Introduction Posterior reversible encephalopathy syndrome (PRES) is a self-limiting neurological condition usually seen in young to middle-aged adults. Although most cases occur in the context of hypertension, PRES is not uncommon in normotensives. PRES is a clinico-radiological diagnosis that embodies specific clinical features, risk factors, and imaging findings. This study analyzes the clinico-radiological profile, typical and atypical features, and outcomes of patients presenting with PRES. Methodology This prospective observational study spanned 18 months and included 38 patients with suspected PRES who were referred from the neurology department. The patients' brain MRIs were evaluated, and the affected regions and their signal intensity depicted in the T1-weighted, T2-weighted, fluid attenuation inversion recovery (FLAIR), and diffusion-weighted images were recorded. The pattern of involvement, atypical findings, and predisposing factors were examined. Results The subcortical white matter of the parieto-occipital lobes was the most typical area affected. The atypical regions affected were the cerebellum, thalamus, brainstem, and basal ganglia. Three cases exhibited isolated involvement of infratentorial structures. Spinal cord involvement was observed in two cases, of which one demonstrated dorsal cord involvement. Conclusion Most lesions are reversible. Long-term follow-up is recommended in hemorrhagic PRES and PRES with spinal cord involvement. Radiologists should be aware of the risk factors, and atypical clinical and imaging features to enable an early diagnosis and prevent further complications.