Journal of Current Research in Scientific Medicine

: 2019  |  Volume : 5  |  Issue : 2  |  Page : 128--129

Posterior reversible encephalopathy syndrome and eclampsia: Neuroimaging features

Jamir Pitton Rissardo, Ana Letícia Fornari Caprara 
 Department of Neurology; Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil

Correspondence Address:
Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul

How to cite this article:
Rissardo JP, Fornari Caprara AL. Posterior reversible encephalopathy syndrome and eclampsia: Neuroimaging features.J Curr Res Sci Med 2019;5:128-129

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Posterior reversible encephalopathy syndrome and eclampsia: Neuroimaging features. J Curr Res Sci Med [serial online] 2019 [cited 2020 Apr 4 ];5:128-129
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Full Text

Dear Sir,

We read an article on “Journal of Current Research in Scientific Medicine” with great interest. Sivaguru et al. reported a case of an adult female who developed posterior reversible encephalopathy syndrome (PRES) on her 8th day of postpartum along with subarachnoid hemorrhage.[1]

PRES is a rare but severe condition of the central nervous system, which has a distinctive neuroimaging. In the last decades, numerous reports have been published. In this context, epidemiological data should be interpreted with caution, since the syndrome is probably underdiagnosed due to the variety in clinical presentations, radiological findings, and underlying risk factors.

We would like to address some important points that together with the study of Sivaguru et al. could lead to a better understanding of this disorder. In a review about PRES, it was found that a significant number of patients with eclampsia will have changes compatible with PRES once diagnosed by appropriate imaging such as magnetic resonance imaging (MRI) scan of the brain in T2 fluid-attenuated inversion recovery-sequence.[2] In this way, neuroimaging alone could not rule out the diagnosis of PRES secondary to a preeclamptic state, even if petechial cortical hemorrhages or cerebral venous thrombosis may occur. Therefore, some experts recommend that we should reserve a brain MRI for patients with atypical presentations.[3]

Another interesting fact is that even though PRES is called “reversible,” although PRES is known as a reversible syndrome, clinical and radiological sequels have been reported in literature. A review that assessed the long-term consequences of the PRES in preeclampsia-eclampsia (PEE) found that the brain imaging features are reversible.[4] In another study about clinical and radiological differences in PRES between individuals with PEE and other predisposing diseases, the PEE subjects had mild forms of PRES with fewer sequels when compared to the other groups.[5] However, retrospective studies found permanent changes on brain MRI, which these lasting features probably are associated with the acute phase clinical manifestation, mainly seizures number, and primary MRI findings.[2]

We agree with the statement of Sivaguru et al. that PRES may be completely reversible with early management, but late diagnosis may cause severe and irreversible complications.[1]

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1Sivaguru N, Indira KM, Pradeep K, Gopinath L, Iqbal N. Posterior reversible encephalopathy syndrome. J Curr Res Sci Med 2018;4:109.
2Feske SK. Posterior reversible encephalopathy syndrome: A review. Semin Neurol 2011;31:202-15.
3Wagner SJ, Acquah LA, Lindell EP, Craici IM, Wingo MT, Rose CH, et al. Posterior reversible encephalopathy syndrome and eclampsia: Pressing the case for more aggressive blood pressure control. Mayo Clin Proc 2011;86:851-6.
4Postma IR, Slager S, Kremer HP, de Groot JC, Zeeman GG. Long-term consequences of the posterior reversible encephalopathy syndrome in eclampsia and preeclampsia: A review of the obstetric and nonobstetric literature. Obstet Gynecol Surv 2014;69:287-300.
5Liman TG, Bohner G, Heuschmann PU, Scheel M, Endres M, Siebert E. Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia-eclampsia and other predisposing diseases. Eur J Neurol 2012;19:935-43.