Posterior Reversible Encephalopathy Syndrome: Is it Always Posterior and Reversible?

Posterior reversible encephalopathy syndrome is a clinical and imagological acute problem characterized by impairment of consciousness, headache, cortical blindness and, epileptic seizures associated with grey and white edema principally localized in temporal-parietal-occipital areas, frequently related hypertensive pregnancy disease. However, not all the cases are associated with pre-eclampsia and eclampsia, and not all of them are related to posterior cerebral edema changes. In this paper is showing ten cases from a Mexican hospital, not all related to pregnancy, neither to posterior vasogenic edema in the image. The immunological patterns were an holo-hemispheric watershed, superior frontal sulcus pattern, dominant parietal-occipital pattern, and a partial or asymmetric abnormality in occipital region bilaterally. Besides the hypertensive disease of pregnancy, we found and hypertensive emergency, renal disease, sepsis, autoimmune illness as etiology. The most had a satisfactory evolution however one was discharged with the minimally conscious state, and another died with a final diagnosis of vasculitis associated with tuberculosis. Therefore, the final result is not always reversible, and neither the image shows a posterior characteristic vasogenic edema.

Keywords: Posterior reversible encephalopathy syndrome; Vasogenic edema; Hypertension; Hypertensive disease of pregnancy