Comparison of magnetic resonance imaging, clinical, and laboratory findings in atypical and typical posterior reversible encephalopathy syndrome

Yıl 2025, Cilt: 50 Sayı: 3, 883 - 889, 30.09.2025

Gülen Gül Mert , Ömer Kaya , Arzu Shahveranova , Yusuf Kenan Bıçakçı

https://doi.org/10.17826/cumj.1720149

Öz

Purpose: The aim of the study is to compare cases defined as typical and atypical Posterior Reversible Encephalopathy Syndrome (PRES) based on the regions of involvement and imaging features in terms of clinical findings and laboratory values.
Materials and Methods: The study included 79 patients who were evaluated as PRES according to imaging and clinical findings between January 2012 and March 2022, had sufficient clinical and laboratory data, and had optimal magnetic resonance (MR) images. Thirty-two of the patients were male, 47 were female, and 61 patients were in the pediatric age group. All patients had non-contrast FLAIR, T1 and T2-weighted images, 24 patients had diffusion-weighted images, and 43 patients had contrast-enhanced T1-weighted images. Patients were divided into typical and atypical groups according to MR imaging findings. Each group was compared independently according to clinical and laboratory data.
Results: Hemorrhage was detected in 2, diffusion restriction in 16, enhancement in 13, and lesions located in deep white and gray matter in 10 patients. According to the areas of involvement, parietooccipital was detected in 11 patients, posterior frontotemporal in 28 patients, cerebellar in 29 patients, brainstem in 5 patients, and thalamus in 6 patients. According to the localization, while the change in consciousness was observed in 41% of the typical group, this was more in the atypical group (72%). In addition, inorganic phosphorus and potassium values were lower in the atypical group. Change in consciousness was detected more in patients with enhancement compared to patients without enhancement. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) values were significantly higher in the atypical group. No significant difference was detected in other data.
Conclusion: Atypical localization and MR imaging features in PRES cases may lead to potential diagnostic difficulties and traps for radiologists evaluating these scans in emergency situations. In addition, some clinical and laboratory findings may be worse in atypical cases, and early and correct diagnosis is very important for treatment management.

Anahtar Kelimeler

MRI , atypical features , Posterior Reversible Encephalopathy Syndrome (PRES)

Atipik ve tipik posterior reversibl ensefalopati sendromunda manyetik rezonans görüntüleme, klinik ve laboratuvar bulgularının karşılaştırılması

Öz

Amaç: Çalışmanın amacı, tutulum bölgeleri ve görüntüleme özelliklerini baz alınarak tipik ve atipik Posterior Reversibl Ensefalopati Sendromu (PRES) olarak tanımlanan olguları klinik bulgular ve laboratuvar özellikleri açısından karşılaştırmaktır.
Gereç ve Yöntem: Çalışmaya Ocak 2012-Mart 2022 tarihleri arasında görüntüleme ve klinik bulgulara göre PRES olarak değerlendirilen, yeterli klinik ve laboratuvar verileri bulunan, manyetik rezonans (MR) görüntüleri optimal olan 79 hasta dahil edilmiştir. Hastaların 32’si erkek, 47’si kadın olup 61 hasta pediatrik yaş grubundaydı. Hastaların tamamında kontrastsız FLAIR, T1 ve T2 ağırlıklı görüntüler, 24 hastada difüzyon ağırlıklı görüntüler ve 43 hastada kontrastlı T1 ağırlıklı görüntüler mevcuttu. MR görüntüleme bulgularına göre hastalar tipik ve atipik gruplara ayrıldı. Her grup birbirinden bağımsız olarak klinik ve laboratuvar verilerine göre karşılaştırıldı.
Bulgular: Kanama 2, difüzyon kısıtlılığı 16, kontrastlanma 13 ve derin beyaz ve gri cevherde yerleşimli lezyonlar 10 hastada saptandı. Tutulum alanlarına göre paryetooksipital 11, posterior frontotemporal 28, serebellar 29, beyin sapı 5, talamus 6 hastada saptandı. Lokalizasyona göre tipik grupta bilinç değişikliği 41% oranda izlenirken, atipik grupta bu daha fazlaydı (72%). Ayrıca inorganik fosfor ve potasyum değerleri atipik grupta daha düşüktü. Kontrastlanma saptanmayan hastalara göre kontrastlanma görülen hastalarda bilinç değişikliği daha fazla saptandı. Alanin aminotransferaz (ALT) ve Aspartat aminotransferaz (AST) değerleri atipik grupta kantitaf olarak yüksek saptandı. Diğer verilerde anlamlı farklılık saptanmadı.
Sonuç: PRES olgularında atipik lokalizasyon ve MR görüntüleme özellikleri acil durumlarda bu taramaları değerlendiren radyologlar için potansiyel tanısal zorluklara ve tuzaklara yol açabilir. Ayrıca atipik olgularda bazı klinik ve laboratuvar bulgular daha kötü seyredebilmekte olup erken ve doğru tanı tedavi yönetimi için çok önemlidir.

Anahtar Kelimeler

MRG , atipik özellikler , Posterior Reversibl Ensefalopati Sendromu (PRES)

Kaynakça

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