Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical symptoms of headache, disturbance of consciousness, seizures and visual disturbances. Neuroimaging shows brain edema, mainly in the occipital, parietal and temporal lobes and basal ganglia, and the clinical signs and abnormalities visible on imaging are always reversible. The most common causes of PRES are hypertensive encephalopathy, eclampsia, renal failure, and use of immunosuppressive agents and steroids. Pathologically, PRES is thought to be caused by disruption of the blood-brain barrier. We describe 5 patients with PRES. All patients were female (mean age, 33 years). At onset, the clinical manifestations were headache, seizure, visual disturbance and hypertension. On magnetic resonance imaging (MRI), most patients had brain edema in the occipital lobe, temporal lobe and basal ganglia, while 1 patient had brain stem and cerebellar edema, and another had a caudate nucleus hemorrhage. Most lesions revealed high signal intensities on apparent diffusion coefficient (ADC) maps and represented vasogenic edema pathologically. Receiving MRI examination at an early stage, patients were treated with antihypertensive and antiepileptic medications, and those who were pregnant immediately underwent a cesarean section. All patients made a complete recovery. In general, PRES has a benign course; however, delayed diagnosis and treatment may lead to increased morbidity. We need to consider PRES for patients with characteristic symptoms and causes. Prompt imaging examinations using mainly MRI and following appropriate therapy including removal of the causative factors, are critically important.
