Clinico-radiological spectrum of obstetric patients with posterior reversible encephalopathy syndrome in a tertiary care hospital

Neenu Alexander, C. Justin


Background: Posterior reversible encephalopathy syndrome (PRES) is a disorder that is not uncommon in pregnancy induced hypertension. We have studied the clinico radiological profile of such patients to understand history, symptomatology and neuro imaging findings of this entity.

Methods: The present study included 20 patients of PRES among the inpatients of a tertiary care hospital in south India from January to March 2020.

Results: Mean age 25.0 years. Most common symptoms included seizures and headache followed by vomiting, visual disturbances.9 patients (45%) had parieto-occipital signal changes on neuro imaging. Magnetic imaging resonance (MRI) (n=20) revealed involvement of atypical sites viz. frontal (30%), temporal (20%), cerebellum (20%), basal ganglia (20%), deep white matter (30%) and brainstem (10%).Diffusion restriction was seen in 40% patients.

Conclusions: Atypical MRI presentations of PRES are common and there is a need to consider a strong possibility for the diagnosis of PRES.


Posterior reversible encephalopathy syndrome, Eclampsia, Hypertension

Full Text:



Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007;28:1320-7.

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;85:427-32.

Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al. Hypertensive encephalopathy: Findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159:379-83.

Schwartz RB, Bravo SM, Klufas RA, Hsu L, Barnes PD, Robson CD, et al. Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol. 1995;165:627-31.

Cho HJ, Lee HJ. Posterior reversible encephalopathy syndrome in early postpartum woman. Hong Kong J Emerg Med. 2012;19:58-61.

Pedraza R, Marik PE, Varon J. Posterior reversible encephalopathy syndrome: A review. Crit Care Shock. 2009;12:135-43.

Brewer J, Owens MY, Wallace K Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208:468.e1-6.

McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: Incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904-12.

Bansal S, Bansal R, Goyal MK, Takkar A, Singh R, Singh P et al. Clinical, Etiological and Imaging Profile of Posterior Reversible Encephalopathy Syndrome: A Prospective and Follow‑Up Study. Annals Indian Acad Neurol.

Rajoor UG, Seema BN. Clinico-radiological spectrum of posterior reversible encephalopathy syndrome: A study from teaching hospital in North Karnataka. Int J Sci Stud. 2015;3:111-4.

Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494 500.