{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:48:40Z","timestamp":1793317720241,"version":"4.5.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006254","name":"Ruhr-Universit\u00e4t Bochum","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006254","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Posterior reversible encephalopathy syndrome (PRES) is clinical-neuroradiologically defined and potentially reversible, so there are limited data about histopathological findings. We aimed to describe the clinical and paraclinical features of patients with PRES with regard to its reversibility.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This retrospective case series encompasses 15 PRES cases out of 1300 evaluated patients from a single German center between January 1, 2010, and June 15, 2020. PRES was established according to the diagnostic criteria as proposed by the Berlin PRES Study 2012. One of the cases studied was subject to brain autopsy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>From the 15 patients studied (median age 53 years, range 17\u201373; 11 female), 67\u2009% presented with epileptic seizures, 40\u2009% suffered from encephalopathy with reduced consciousness and 53\u2009% developed delirium, while 47\u2009% had headache and visual disturbances. Subcortical brain MRI abnormalities related to PRES were observed in all patients. One patient developed spinal ischemia and another Guillain-Barr\u00e9 syndrome in addition to PRES. Hypertensive blood pressure was the main underlying\/trigger condition in all patients. Clinical symptoms and MRI changes were not reversible in 42\u2009%, even progressive in 3 out of these 5 patients. Median time from symptom onset to diagnosis in these non-reversible cases was 7 days (range 0\u201313), while the median delay in diagnosis in the reversible group was 1\u00a0day (range 0\u20133). Cerebellar\/brain stem involvement and status epilepticus were more frequently in patients with non-reversible disease course. Mortality due to PRES occurred in 13\u2009% of these patients. Neuropathological examination of the brain of a 57-year-old female patient revealed major leukencephalopathic changes, fibrinoid necrosis of endothelial cells and fresh petechial hemorrhages in accordance with PRES.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our case series demonstrates that PRES was not reversible in 42\u2009% of the studied patients. Delay in diagnosis seems to contribute to limited reversibility and poor outcome.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02408-0","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T20:43:57Z","timestamp":1633639437000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A broad spectrum of posterior reversible encephalopathy syndrome - a case series with clinical and paraclinical characterisation, and histopathological findings"],"prefix":"10.1186","volume":"21","author":[{"given":"Fatme Seval","family":"Ismail","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"van de Nes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilka","family":"Kleffner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,6]]},"reference":[{"key":"2408_CR1","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s00415-011-6152-4","volume":"259","author":"TG Liman","year":"2012","unstructured":"Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol. 2012;259:155\u201364.","journal-title":"J Neurol"},{"key":"2408_CR2","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1093\/jnen\/nlx112","volume":"77","author":"N Willard","year":"2018","unstructured":"Willard N, Honce JM, Kleinschmidt-DeMasters BK. PRES: review of histological features. J Neuropathol Exp Neurol. 2018;77:100\u201318.","journal-title":"J Neuropathol Exp Neurol"},{"key":"2408_CR3","first-page":"1038","volume":"23","author":"DJ Covarrubias","year":"2002","unstructured":"Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol. 2002;23:1038\u201348.","journal-title":"AJNR Am J Neuroradiol"},{"key":"2408_CR4","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1097\/01.rct.0000233127.21303.b9","volume":"31","author":"JM Sweany","year":"2007","unstructured":"Sweany JM, Bartynski WS, Boardman JF. \"Recurrent\u201d posterior reversible encephalopathy syndrome: report of 3 cases\u2013PRES can strike twice! J Comput Assist Tomogr. 2007;31:148\u201356.","journal-title":"J Comput Assist Tomogr"},{"key":"2408_CR5","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/S1474-4422(15)00111-8","volume":"14","author":"JE Fugate","year":"2015","unstructured":"Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14:914\u201325.","journal-title":"Lancet Neurol"},{"key":"2408_CR6","doi-asserted-by":"publisher","first-page":"397","DOI":"10.2350\/09-04-0634-CR.1","volume":"13","author":"JN Kheir","year":"2010","unstructured":"Kheir JN, Lawlor MW, Ahn ES, Lehmann L, Riviello JJ, Silvera VM, et al. Neuropathology of a fatal case of posterior reversible encephalopathy syndrome. Pediatr Dev Pathol. 2010;13:397\u2013403.","journal-title":"Pediatr Dev Pathol"},{"key":"2408_CR7","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.jns.2017.02.030","volume":"375","author":"Y Hayashi","year":"2017","unstructured":"Hayashi Y, Kimura A, Nakamura H, Mimuro M, Iwasaki Y, Hara A, et al. Neuropathological findings from an autopsied case showing posterior reversible encephalopathy syndrome-like neuroradiological findings associated with premedication including tacrolimus for autologous peripheral blood stem cell transplantation. J Neurol Sci. 2017;375:382\u20137.","journal-title":"J Neurol Sci"},{"key":"2408_CR8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/jnnp-2017-316225","volume":"89","author":"B Gao","year":"2018","unstructured":"Gao B, Lyu C, Lerner A, McKinney AM. Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years? J Neurol Neurosurg Psychiatry. 2018;89:14\u201320.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2408_CR9","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.3174\/ajnr.A0549","volume":"28","author":"WS Bartynski","year":"2007","unstructured":"Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007;28:1320\u20137.","journal-title":"AJNR Am J Neuroradiol"},{"key":"2408_CR10","first-page":"205","volume":"65","author":"VH Lee","year":"2008","unstructured":"Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65:205\u201310.","journal-title":"Arch Neurol"},{"key":"2408_CR11","doi-asserted-by":"publisher","first-page":"e191","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.02.014","volume":"24","author":"MH Harirchian","year":"2015","unstructured":"Harirchian MH, Ghaffarpour M, Tabaeizadeh M, Siroos B. Immunosuppressive drugs, an emerging cause of posterior reversible encephalopathy syndrome: case series. J Stroke Cerebrovasc Dis. 2015;24:e191-195.","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2408_CR12","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s11916-020-00932-1","volume":"25","author":"AN Gewirtz","year":"2021","unstructured":"Gewirtz AN, Gao V, Parauda SC, Robbins MS. Posterior reversible encephalopathy syndrome. Curr Pain Headache Rep. 2021;25:19.","journal-title":"Curr Pain Headache Rep"},{"key":"2408_CR13","doi-asserted-by":"publisher","first-page":"117019","DOI":"10.1016\/j.jns.2020.117019","volume":"416","author":"SC Parauda","year":"2020","unstructured":"Parauda SC, Gao V, Gewirtz AN, Parikh NS, Merkler AE, Lantos J, White H, Leifer D, Navi BB, Segal AZ. Posterior reversible encephalopathy syndrome in patients with COVID-19. J Neurol Sci. 2020;416:117019.","journal-title":"J Neurol Sci"},{"key":"2408_CR14","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.jocn.2021.03.028","volume":"88","author":"S Lallana","year":"2021","unstructured":"Lallana S, Chen A, Requena M, Rubiera M, Sanchez A, Siegler JE, Muchada M. Posterior reversible encephalopathy syndrome (PRES) associated with COVID-19. J Clin Neurosci. 2021;88:108\u201312.","journal-title":"J Clin Neurosci"},{"key":"2408_CR15","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1177\/1941874418802061","volume":"9","author":"CA Ellis","year":"2019","unstructured":"Ellis CA, McClelland AC, Mohan S, Kuo E, Kasner SE, Zhang C, Khankhanian P, Balu R. Cerebrospinal fluid in posterior reversible encephalopathy syndrome: implications of elevated protein and pleocytosis. Neurohospitalist. 2019;9:58\u201364.","journal-title":"Neurohospitalist"},{"key":"2408_CR16","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s00415-015-7928-8","volume":"263","author":"L Neeb","year":"2016","unstructured":"Neeb L, Hoekstra J, Endres M, Siegerink B, Siebert E, Liman TG. Spectrum of cerebral spinal fluid findings in patients with posterior reversible encephalopathy syndrome. J Neurol. 2016;263:30\u20134.","journal-title":"J Neurol"},{"key":"2408_CR17","doi-asserted-by":"publisher","first-page":"34","DOI":"10.3389\/fneur.2020.00034","volume":"11","author":"F Pilato","year":"2020","unstructured":"Pilato F, Distefano M, Calandrelli R. Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome: clinical and radiological considerations. Front Neurol. 2020;11:34.","journal-title":"Front Neurol"},{"key":"2408_CR18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jns.2014.09.019","volume":"347","author":"LM Alhilali","year":"2014","unstructured":"Alhilali LM, Reynolds AR, Fakhran S. A multi-disciplinary model of risk factors for fatal outcome in posterior reversible encephalopathy syndrome. J Neurol Sci. 2014;347:59\u201365.","journal-title":"J Neurol Sci"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02408-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02408-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02408-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T20:44:01Z","timestamp":1633639441000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02408-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,6]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2408"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02408-0","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,6]]},"assertion":[{"value":"10 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures\/protocols were in accordance with the ethic guidelines of the Ruhr University Bochum. All methods were carried out in accordance with relevant guidelines and regulations. According to legislative regulations in Germany, North Rhine-Westphalia and after consultation of the Institutional Review Board, Medical Faculty of the Ruhr University Bochum, the need for ethical approval and consent is deemed unnecessary for this retrospective case series with data collected during routine clinical work. Approval for brain autopsy was obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"386"}}