Neurocritical Care

, Volume 4, Issue 2, pp 133–136 | Cite as

Posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy and acute uremia

  • Mustafa Gokce
  • Ekrem Dogan
  • Saadet Nacitarhan
  • Gulen Demirpolat
Practical Pearl



The posterior reversible encephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiological entity. The most common causes of PRES are hypertensive encephalopathy, eclampsia, cyclosporin A neurotoxicity, and the uremic encephalopathy. On magnetic resonance imaging (MRI) studies, edema has been reported in a relatively symmetrical pattern, typically in the subcortical white matter and occasionally in the cortex of the posterior circulation area of the cerebrum.

Methods and Results

A 19-year-old woman undergoing chronic hemodialysis was admitted with encephalopathy. High signal intensity was seen bilaterally in the subcortical and deep white matter areas of the temporal, frontal, parietal, and occipital lobes on cranial MRI.


Particular attention needs to be given to PRES because initiation of appropriate intervention can reverse the encephalopathic condition in most cases. Cerebral lesions may be more prominent in the anterior circulation area in some patients.

Key Words

Posterior reversible encephalopathy syndrome uremia hypertensive encephalopathy FLAIR MRI 


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  1. 1.
    Hinchey J, Chaves C, Appigani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494–500.PubMedCrossRefGoogle Scholar
  2. 2.
    Lamy C, Oppenheim C, Meder JF, Mas JL. Neuroimaging in posterior reversible encephalopathy syndrome. J Neuroimaging 2004;14:89–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Ugurel MS, Hayakawa M. Implications of post-gadolinium MRI results in 13 cases with posterior reversible encephalopathy syndrome. Eur J Radiol 2005;53:441–449.PubMedCrossRefGoogle Scholar
  4. 4.
    Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg 2004;107:1–16.PubMedCrossRefGoogle Scholar
  5. 5.
    Burn DJ, Bates D. Neurology and the kidney. J Neurol Neurosurg Psychiatry 1998;65:810–821.PubMedCrossRefGoogle Scholar
  6. 6.
    Okada J, Yoshikawa K, Matsuo H, Kanno K, Oouchi M. Reversible MRI and CT findings in uremic encephalopathy. Neuroradiol 1991;33:524–526.CrossRefGoogle Scholar
  7. 7.
    Komatsu Y, Shinghara A, Kukita C, Nose T, Maki Y. Reversible CT changes in uremic encephalopathy. AJNR Am J Neuroradiol 1988;9:215–216.PubMedGoogle Scholar
  8. 8.
    Sitter T, Lederer SR, Held E, Schiffl H. Reversible MRI changes in a patient with uremic encephalopathy. J Nephrol 2001;14: 424–427.PubMedGoogle Scholar
  9. 9.
    Lamy C, Mas JL. Hypertensive encephalopathy. In: Mohr JP, Choi D, Grota JC, Weir B, Wolf PA, eds. Stroke: pathophysiology, diagnosis and management, 4th ed. Philadelphia: Churchill Livingstone 2004:641–647.Google Scholar
  10. 10.
    Ay H, Buonanno FS, Schaefer PW, et al. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology 1998;51:1369–76.PubMedGoogle Scholar

Copyright information

© Humana Press Inc 2006

Authors and Affiliations

  • Mustafa Gokce
    • 1
  • Ekrem Dogan
    • 2
  • Saadet Nacitarhan
    • 1
  • Gulen Demirpolat
    • 3
  1. 1.Department of Neurology, Medical SchoolUniversity of KahramanmarasKahramanmarasTurkey
  2. 2.Department of Internal Medicine, Medical SchoolUniversity of KahramanmarasKahramanmarasTurkey
  3. 3.Department of Radiology, Medical SchoolUniversity of KahramanmarasKahramanmarasTurkey

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