Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema

Alexander M McKinney, Bharathi D Jagadeesan, Charles L Truwit
AJR. American Journal of Roentgenology 2013, 201 (3): 631-8

OBJECTIVE: Although posterior reversible encephalopathy syndrome (PRES) typically involves cortical or subcortical edema of the cerebrum, only individual cases have been described of a variant involving the central brainstem and basal ganglia and lacking cortical and subcortical edema. We evaluated FLAIR and T2-weighted images of 124 patients with confirmed PRES to determine the incidence of this uncommon variant, which we refer to as the "central variant"; to determine which structures are involved in this variant; and to determine the associated causes.

CONCLUSION: We found that five of the 124 patients (4%) with PRES had MR findings consistent with the central variant-that is, either brainstem or basal ganglia involvement and a lack of cortical or subcortical edema of the cerebrum. The thalami were involved in all five PRES patients with MR findings consistent with the central variant, but there was variable involvement of the posterior limb of the internal capsule (4/5), cerebellum (3/5), and periventricular white matter (3/5); in each patient, there was improvement both clinically and on MRI. The causes of PRES in these five patients were hypertension (n=2), cyclosporine (n=2), and eclampsia (n=1). The incidence of the central variant may be increasing because of an improving awareness of the diverse imaging patterns of PRES.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"