Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro Acute radiological pattern and outcome in posterior reversible encephalopathy syndrome patients Fabio Pilato a, ⁎ , Rosalinda Calandrelli b , Marisa Distefano a , Marco Panfili b , Giacomo Della Marca a , Cesare Colosimo b a UOC Neurologia, Dipartimento di scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Roma, Italy b UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Roma, Italy ARTICLE INFO Keywords: Posterior reversible encephalopathy syndrome PRES MRI Hypertensive encephalopathy ABSTRACT Objective: : Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of acute or subacute onset characterized by varied neurological symptoms including headache, impaired visual acuity or visual field deficits, confusion, disorders of consciousness, seizures, and motor neurological deficits. Even if recognition of severe forms of PRES has improved, mainly due to magnetic resonance imaging, pa- thogenesis is still unclear and management of these patients remains challenging. Moreover, prognosis is un- predictable varying from complete recovery to death and factors related to prognosis are still lacking. We studied early magnetic resonance imaging characteristics and their relationships with prognosis. Patients and Methods: We performed a retrospective analysis in patients with clinical and neuroradiological charateristics of PRES performing magnetic resonance of the brain within 2 days of symptoms onset. Results: After reviewing site database of magnetic resonance imaging and clinical records compatible with PRES, 157 patients were selected. After imaging reviewing, 25 patients with clinical and neuroradiological diagnosis of PRES were enrolled, 22 (88%) females. Mean age of enrolled patients at presentation was 44.4+18.4 years (range, 21–84 years). Patients were classified according to neuroradiological characteristics such as ischemic lesions, distribution and severity of edema, hemorrhage and contrast enhancement. In our group 23 patients (92%) showed an almost complete recovery but 2 patients (8%) died during hospitalization. Outcome was significantly related with hypointensity on ADC (p = 0.002) and CE (p < 0.001). Conclusion: Early MR features may be helpful in suggesting prognosis. Moreover, neuroimaging at the early stage of PRES may give new insights in pathophysiological mechanisms underlying brain damage and neuro- logical impairment. 1. Introduction The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of acute or subacute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits occurring in association with several predisposing conditions. PRES is also known as reversible pos- terior leukoencephalopathy syndrome but other authors labelled it hyperperfusion encephalopathy, or brain capillary leak syndrome; none of these names is completely satisfactory because the syndrome is not always reversible, and it is often not confined to either the white matter or the posterior regions of the brain [1–3]. Since its first description in 1996 [1], risk factors associated with the development of PRES in- cluding hypertension, preeclampsia, renal failure, autoimmune dis- orders, immunosuppression, malignancy, sepsis, transplantation and receipt of chemotherapeutic medications remained unchanged but it may occurs also in healthy subjects [1–3]. PRES is usually reversible and monophasic [4] but recurrence has been described [5]. PRES is becoming increasingly recognised, in large part because of improved https://doi.org/10.1016/j.clineuro.2019.105459 Received 20 October 2018; Received in revised form 30 June 2019; Accepted 4 August 2019 ⁎ Corresponding author at: UOC Neurologia, Dipartimento di scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo; Fondazione Policlinico Universitario A. Gemelli – IRCCS, 00168 Roma, Italy. E-mail addresses: fabio.pilato@policlinicogemelli.it (F. Pilato), rosalinda.calandrelli@policlinicogemelli.it (R. Calandrelli), marisa.distefano@hotmail.it (M. Distefano), marco.panfili@gmail.com (M. Panfili), giacomo.dellamarca@policlinicogemelli.it (G. Della Marca), cesare.colosimo@policlinicogemelli.it (C. Colosimo). Clinical Neurology and Neurosurgery 185 (2019) 105459 Available online 08 August 2019 0303-8467/ © 2019 Elsevier B.V. All rights reserved. T