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Table 1 Main clinical and MRI features, treatment and outcome of 15 patients with PRES with regard to its reversibility

From: A broad spectrum of posterior reversible encephalopathy syndrome - a case series with clinical and paraclinical characterisation, and histopathological findings

Patient, sex, age at onset in years

Underlying conditions/disease trigger

Main clinical features

Time (in days) from symptom onset to diagnosis

mRS (0–6) at admission

Brain MRI

Treatment

(1) anticonvulsive medication

(2) intravenous blood pressure medication

Outcome (mRS 0–6 at discharge)

Clinical and radiological reversibility

Reversible

 #1, F, 17

Arterial hypertension, coproporphyria

Epileptic seizure, impaired vision bilateral

2

2

T2/FLAIR hypersignal with diffusion impairment bi-parieto-temporo-occipital, centrum semiovale bilateral frontal

(1) Levetiracetam

0

Complete

 #2, F, 57

Arterial hypertension, polychemotherapy, immunsuppressiva (anti-thymocyte globulin (ATG), mycophenolate mofetil (MMF), cyclosporine A (CsA), allogeneic stem cell transplantation

Headache, delirium, impaired vision; in addition to PRES Guillain-Barré syndrome

0

3

T2 hypersignal bi-parieto-occipital and bi-cerebellar, diffusion impairment cortical bi-occipital, contrast enhancement

(2) Urapidil

6 (due to septic shock)

Complete

 #3, F, 36

Eclampsia in the puerperium (condition after sectio 3 days ago), hypertensive crisis

Epileptic seizure, headache

2

2

T2/FLAIR hypersignal (white matter) biparieto-occipital, right frontal and lateral of left basal ganglia; sulcal subarachnoidal hemorrhage left temporal

(2) Urapidil, dihydralazine

0

Complete

 #4, F, 53

Arterial hypertension, immunsuppressiva (tacrolimus), condition after kidney transplantation

Headache, impaired vision, epileptic seizures, delirium, impaired consciousness

1

4

T2 hypersignal (juxtacortical) bi-fronto-parietal, intracerebral hemorrhage with edema bi-occipital (right > left), sulcal subarachnoidal hemorrhage right temporo-parietal and insular

(1) Levetiracetam, phenytoine

(2) Clonidine, dihydralazine

3

Incomplete

 #5, M, 29

Arterial hypertension

Headache, loss of vision both sides

3

4

T2 hypersignal subcortical bi-occipital and left temporo-parietal

(1) Levetiracetam

2

Incomplete

 #6, M, 72

Arterial hypertension

Epileptic seizure, confusion, impaired vision, impaired consciousness

0

4

FLAIR hypersignal (cortical and subcortical) bi-temporo-occipital, hemorrhagic transformation, intrasulcal subarachnoidal hemorrhage bi-temporo-occipital; spinal ischemia (A. spinalis anterior, thoracic T8 extending to the conus)

(1) Levetiracetam

(2) Urapidil

4

Incomplete

 #7, M, 66

Serotonin syndrome due to venlafaxine with hypertension, tachykardia and fever

delirium, hallucinations, impaired consciousness

1

5

T2/FLAIR hypersignal bi-cerebellar, bi-parieto-temporal, left frontal, diffusion impairment right post-central and right cerebellar; contrast enhancement of the meninges

(1) Levetiracetam

(2) Urapidil, metoprolol

3

Incomplete

Non-Reversible

 #8, F, 39

Arterial hypertension

Impaired vision bilateral, fundus hypertonicus

13

2

T2 hypersignal subcortical bihemispheric, more temporomesial, bi-cerebellar, in pons, medulla oblongata, contrast enhancement

(2) Urapidil, dihydralazine, clonidine

1

No

 #9, F, 34

Arterial hypertension, end-stage renal failure with bilateral nephrectomy and dialysis

Headache, cortical blindness, epileptic seizures with convulsive focal status epilepticus

0

4

T2/FLAIR hypersignal bi-parieto-occipital, cortical and subcortical, diffusion lesions bihemispheric (bi-occipital, right temporal, left frontal)

(1) Levetiracetam

(2) Urapidil, clonidine, dihydralazine

4

No

 #10, F, 54

Arterial hypertension

Impaired consciousness, anisocoria, facial nerve paralysis left, gaze paresis

7

2

T2 hypersignal subcortical bihemispheric, diffusion impairment bi-cerebellar, in pons, medulla oblongata and basal ganglia bilateral, contrast enhancement in the capsula interna right

(2) Urapidil, dihydralazine

5

Progressive

 #11, F, 57

Arterial hypertension; hypertensive encephalopathy (PRES) in the history 5 years ago

Headache, nausea, vomiting, generalized epileptic seizures with convulsive status epilepticus, mnestic deficits, agitation, impaired consciousness

7

3

Extensive symmetric and bihemispheric diffusion impairment (frontal, parietooccipital, cerebellar, temporal) with T2/FLAIR hypersignal (subcortical and cortical)

(1) Levetiracetam, valproate

6 (due to PRES)

Progressive

 #12, M, 71

Arterial hypertension

Epileptic seizures with convulsive and later non-convulsive status epilepticus, delirium

10

3

T2 hypersignal (subcortical and cortical) bi-occipital, bi-cerebellar, corpus callosum, mesencephalon

(1) Levetiracetam, valproate, lacosamide

(2) Urapidil

6 (due to PRES)

Progressive

Not-available

 #13, F, 73

Arterial hypertension

Epileptic seizures, delirium

1

4

Extensive bihemispheric white matter edema (right frontal, right parietooccipital, left occipital) with T2/FLAIR hypersignal (subcortical), small diffusion impairment right temporal

(1) Levetiracetam, lacosamide

(2) Urapidil, clonidine

3

Transfer to another hospital

 #14, F, 29

Arterial hypertension, eclampsia with emergency Caesarean section

Headache, epileptic seizures

2

2

T2/FLAIR hypersignal (subcortical) bi-occipital

(2) Urapidil

0

Transfer to another hospital

 #15, F, 48

Arterial hypertension

Delirium, epileptic seizures with non-convulsive status epilepticus, impaired consciousness

2

3

T2 hypersignal subcortical and cortical (right > left) parieto-occipital, right thalamus

(1) Levetiracetam

1

Control MRI in outpatient radiology

  1. FLAIR Fluid-attenuated inversion recovery, mRS Modified Rankin Scale, PRES Posterior reversible encephalopathy syndrome