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Posterior Reversible Encephalopathy Syndrome (PRES): Restricted Diffusion does not Necessarily Mean Irreversibility.

Wagih A, Mohsen L, Rayan MM, Hasan MM, Al-Sherif AH - Pol J Radiol (2015)

Bottom Line: The age and blood pressure did not vary significantly between both groups.The total number of regions involved and the FLAIR/DWI score did not vary significantly between both groups.Similarly, ADC values did not reveal any significant difference between both groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Minia University, Minia, Egypt.

ABSTRACT

Background: Restricted diffusion is the second most common atypical presentation of PRES. This has a very important implication, as lesions with cytotoxic edema may progress to infarction. Several studies suggested the role of DWI in the prediction of development of infarctions in these cases. Other studies, however, suggested that PRES is reversible even with cytotoxic patterns. Our aim was to evaluate whether every restricted diffusion in PRES is reversible and what factors affect this reversibility.

Material/methods: Thirty-six patients with acute neurological symptoms suggestive of PRES were included in our study. Inclusion criteria comprised imaging features of atypical PRES where DWI images and ADC maps show restricted diffusion. Patients were imaged with 0.2-T and 1.5-T machines. FLAIR images were evaluated for the severity of the disease and a FLAIR/DWI score was used. ADC values were selectively recorded from the areas of diffusion restriction. A follow-up MRI study was carried out in all patients after 2 weeks. Patients were classified according to reversibility into: Group 1 (reversible PRES; 32 patients) and Group 2 (irreversible changes; 4 patients). The study was approved by the University's research ethics committee, which conforms to the declaration of Helsinki.

Results: The age and blood pressure did not vary significantly between both groups. The total number of regions involved and the FLAIR/DWI score did not vary significantly between both groups. Individual regions did not reveal any tendency for the development of irreversible lesions. Similarly, ADC values did not reveal any significant difference between both groups.

Conclusions: PRES is completely reversible in the majority of patients, even with restricted diffusion. None of the variables under study could predict the reversibility of PRES lesions. It seems that this process is individual-dependent.

No MeSH data available.


Related in: MedlinePlus

A 24-year-old female presented with pre-partum fits. (A) FLAIR image reveals lesions of abnormal signal intensity, suggestive of PRES, within bilateral basal ganglia (red arrows) and in the occipital lobe. (B) DW image reveals increased signal intensity in the basal ganglia bilaterally (red arrows). (C) FLAIR image at follow-up reveals complete resolution.
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f3-poljradiol-80-210: A 24-year-old female presented with pre-partum fits. (A) FLAIR image reveals lesions of abnormal signal intensity, suggestive of PRES, within bilateral basal ganglia (red arrows) and in the occipital lobe. (B) DW image reveals increased signal intensity in the basal ganglia bilaterally (red arrows). (C) FLAIR image at follow-up reveals complete resolution.


Posterior Reversible Encephalopathy Syndrome (PRES): Restricted Diffusion does not Necessarily Mean Irreversibility.

Wagih A, Mohsen L, Rayan MM, Hasan MM, Al-Sherif AH - Pol J Radiol (2015)

A 24-year-old female presented with pre-partum fits. (A) FLAIR image reveals lesions of abnormal signal intensity, suggestive of PRES, within bilateral basal ganglia (red arrows) and in the occipital lobe. (B) DW image reveals increased signal intensity in the basal ganglia bilaterally (red arrows). (C) FLAIR image at follow-up reveals complete resolution.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4418207&req=5

f3-poljradiol-80-210: A 24-year-old female presented with pre-partum fits. (A) FLAIR image reveals lesions of abnormal signal intensity, suggestive of PRES, within bilateral basal ganglia (red arrows) and in the occipital lobe. (B) DW image reveals increased signal intensity in the basal ganglia bilaterally (red arrows). (C) FLAIR image at follow-up reveals complete resolution.
Bottom Line: The age and blood pressure did not vary significantly between both groups.The total number of regions involved and the FLAIR/DWI score did not vary significantly between both groups.Similarly, ADC values did not reveal any significant difference between both groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Minia University, Minia, Egypt.

ABSTRACT

Background: Restricted diffusion is the second most common atypical presentation of PRES. This has a very important implication, as lesions with cytotoxic edema may progress to infarction. Several studies suggested the role of DWI in the prediction of development of infarctions in these cases. Other studies, however, suggested that PRES is reversible even with cytotoxic patterns. Our aim was to evaluate whether every restricted diffusion in PRES is reversible and what factors affect this reversibility.

Material/methods: Thirty-six patients with acute neurological symptoms suggestive of PRES were included in our study. Inclusion criteria comprised imaging features of atypical PRES where DWI images and ADC maps show restricted diffusion. Patients were imaged with 0.2-T and 1.5-T machines. FLAIR images were evaluated for the severity of the disease and a FLAIR/DWI score was used. ADC values were selectively recorded from the areas of diffusion restriction. A follow-up MRI study was carried out in all patients after 2 weeks. Patients were classified according to reversibility into: Group 1 (reversible PRES; 32 patients) and Group 2 (irreversible changes; 4 patients). The study was approved by the University's research ethics committee, which conforms to the declaration of Helsinki.

Results: The age and blood pressure did not vary significantly between both groups. The total number of regions involved and the FLAIR/DWI score did not vary significantly between both groups. Individual regions did not reveal any tendency for the development of irreversible lesions. Similarly, ADC values did not reveal any significant difference between both groups.

Conclusions: PRES is completely reversible in the majority of patients, even with restricted diffusion. None of the variables under study could predict the reversibility of PRES lesions. It seems that this process is individual-dependent.

No MeSH data available.


Related in: MedlinePlus