title: Clinical and radiological spectrum of posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  Symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental status, visual disturbances, and seizures. Typical radiological features include edema of the parieto-occipital lobes. The purpose of this study is to review the clinical and radiological findings in patients diagnosed with PRES.
  
  
  METHODS
  All patients diagnosed with PRES between January 2006 and December 2012 were retrospectively included in this study. We reviewed demographic and clinical characteristics, and radiological findings.
  
  
  RESULTS
  We identified 16 patients with PRES. The most common clinical presentation was seizure (n = 12, 75%). Clinical recovery occurred in all patients within days (mean, 5.7 ± 4.6 days). Comorbid conditions included hypertension (n = 4, 25%), cytotoxic medications (n = 3, 18.8%), sepsis (n = 4, 25%), malignancy (n = 4, 25%), subarachnoid hemorrhage (n = 1, 6.3%), autoimmune disorders (n = 1, 6.3%) and eclampsia (n = 1, 6.3%). The most commonly involved location was the parieto-occipital lobe (n = 13, 81.3%). Atypical radiological findings included significant basal ganglia involvement in 4 episodes; brainstem in 3, cerebellum in 2, and thalamus in 3. Eleven patients (68.8%) underwent diffusion-weighted imaging and apparent diffusion coefficient mapping. Of those, 9 patients (81.8%) had hypo- or isointensity on diffusion-weighted imaging. On the apparent diffusion coefficient map, 10 patients (90.9%) had hyperintensity, and the other had normal values.
  
  
  CONCLUSIONS
  We suggest that PRES may occur in patients with complex systemic conditions. The prognosis of PRES is usually benign. Physicians should be aware of certain atypical radiological findings to avoid a delayed diagnosis of PRES, as delayed diagnosis and treatment can result in permanent neurological sequlae.
authors.affiliation: Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Sang-Duk
authors.initials: SD
authors.lastname: Yoon
authors.forename: Byung-Moon
authors.initials: BM
authors.lastname: Cho
authors.forename: Sae-Moon
authors.initials: SM
authors.lastname: Oh
authors.forename: Se-Hyuck
authors.initials: SH
authors.lastname: Park
authors.forename: In-Bock
authors.initials: IB
authors.lastname: Jang
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
keywords: Clinical features; Posterior reversible encephalopathy syndrome; Radiological findings