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Clinical Images  |   June 2015
Posterior Reversible Encephalopathy Syndrome
Author Notes
  • From the Department of Radiology at David Grant USAF Medical Center Travis Air Force Base in Fairfield, California (Drs Lewis and O’Brien), and the Department of Radiology at the University of California—Davis School of Medicine in Sacramento (Dr O’Brien). Dr Lewis is a radiology resident. 
  • Disclaimer: The views expressed in this material are those of the authors and do not reflect the official policy or position of the US Government, the Department of Defense, or the Department of the Air Force. 
  •  *Address correspondence to Brian J. Lewis, DO, Department of Radiology, David Grant USAF Medical Center, Travis Air Force Base, 101 Bodin Cir, Fairfield, CA 94535-1809. brianjameslewis@gmail.com
     
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   June 2015
Posterior Reversible Encephalopathy Syndrome
The Journal of the American Osteopathic Association, June 2015, Vol. 115, 401. doi:10.7556/jaoa.2015.082
The Journal of the American Osteopathic Association, June 2015, Vol. 115, 401. doi:10.7556/jaoa.2015.082
A 15-year-old boy undergoing chemotherapy for acute lymphoblastic leukemia presented with new-onset headaches and visual disturbances. Clinical evaluation revealed moderate hypertension, and no focal neurologic deficits were identified. Magnetic resonance imaging demonstrated bilateral regions of cortical and subcortical signal abnormality predominantly within the occipital (image A) and posterior parietal (image B) lobes, consistent with posterior reversible encephalopathy syndrome. After successful treatment for hypertension, the patient’s symptoms completely resolved. 
In posterior reversible encephalopathy syndrome, autoregulation of the intracerebral perfusion is thought to be hindered during a hypertensive episode, resulting in vasogenic edema.1 Owing to a relative decrease in sympathetic innervation, the posterior circulation (posterior temporal, parietal, and occipital lobes) is most often affected.1-3 Common causes include preeclampsia or eclampsia, renal failure, autoimmune disorders, and chemotherapeutic drug toxicities. Patients frequently present with headache, nausea and vomiting, visual disturbances, or seizures.3 Symptoms and imaging findings typically resolve after management of the hypertensive episode. However, complications, including superimposed infarct, necessitate early detection and treatment. 
References
Stevens CJ, Heran MK. The many faces of posterior reversible encephalopathy syndrome. Br J Radiol. 2012; 85(1020): 1566-1575. doi:10.1259/bjr/25273221. [CrossRef] [PubMed]
Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008; 29(6): 1036-1042. doi:10.3174/ajnr.A0928. [CrossRef] [PubMed]
Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010; 85(5): 427-432. doi:10.4065/mcp.2009.0590. [CrossRef] [PubMed]