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The posterior reversible encephalopathy syndrome: what's certain, what's new?
  1. C Roth1,
  2. A Ferbert2
  1. 1Consultant Neurologist, Head of the Neuro-Intensive Care Unit, Department of Neurology, Klinikum Kassel, Kassel, Germany
  2. 2Professor of Neurology, Head of the Department of Neurology, Department of Neurology, Klinikum Kassel, Kassel, Germany
  1. Correspondence to Dr C Roth, Department of Neurology, Klinikum Kassel, Moenchebergstraße 41–43, 34125 Kassel, Germany; roth99{at}web.de

Abstract

The posterior reversible encephalopathy syndrome is an increasingly recognised disorder. Most patients have several symptoms; seizures are the most frequent, often multiple or status epilepticus. A combination of seizures, visual disturbance and/or headache, in particular, should lead to an early brain MRI to reveal the typical pattern of bilateral hyperintensities on fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. There seem to be many possible triggers, including abrupt arterial hypertension, impaired renal function, pregnancy, immunosuppressive therapies and various inflammatory conditions. The clinical outcome is excellent, with recovery within a few days, while the MRI abnormalities resolve much more slowly. Little is known about the best management. Seizures do not normally progress to chronic epilepsy so antiepileptic drugs should be discontinued after about 3 months.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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