Long-term Neurocognitive and Neuroimaging Outcomes in Posterior Reversible Encephalopathy Syndrome: Two Case Reports and Implications

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic and neurometabolic state associated with a distinct appearance on computed tomography and magnetic resonance imaging, as well as particular clinical features. While PRES is defined as a reversible condition, instances of irreversible or persisting cytotoxic edema have been reported and appear to be associated with poor outcomes. Studies addressing the post-acute neurocognitive findings in persisting/irreversible PRES are lacking. We report two cases of persisting PRES with associated neurocognitive deficits and functional limitations following acute presentation. Neuroimaging revealed abnormalities within the posterior parietal lobes, along with bilateral involvement of the occipital and frontal lobes. The results from the neuropsychological examination revealed a pattern of impairment generally affecting spatial-perceptual and related functions and aspects of executive function. These cases document instances of irreversible/persisting PRES with associated neurocognitive deficits and functional limitations generally corresponding with the areas implicated on neuroimaging. Studies addressing the post-acute neurocognitive presentation and functional outcomes of PRES are needed.

Keywords:

• Posterior reversible encephalopathy syndrome
• Pre-eclampsia
• Lupus
• Neurocognitive
• Neuroimaging

Notes

¹While described in the medical record, the authors did not observe limb ataxia. Given the presence of bilateral parietal lobe lesions, it is most likely that the patient failed to touch a target (i.e., the physician's finger) due to mis-reaching, a condition more accurately described as optic ataxia. Since this behavior was not present at the time we examined her, this explanation is only speculative