Posterior reversible encephalopathy syndrome: a 15-year single-center case series of 125 patients

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by typical neuroimaging findings predominantly affecting posterior cerebral regions, associated with symptoms such as headache, visual disturbances, and seizures. Most of the current knowledge regarding PRES derives from case reports and small series, with relatively few large cohorts published. Objective: To describe the clinical, radiological, and etiological characteristics of patients diagnosed with PRES over a 15-year period at a single center. Methods: We analyzed 125 consecutive patients diagnosed with PRES between 2011 and 2026. Demographic data, underlying etiologies, blood pressure levels at presentation, clinical manifestations, and neuroimaging findings were reviewed. Results: Among the 125 patients, 98 were women and 27 were men. Pregnancy-related disorders, including preeclampsia and eclampsia, were the leading associated conditions, followed by renal diseases and immunosuppression or chemotherapy exposure. The occipital lobes were the most frequently involved regions on neuroimaging, followed by the temporal and parietal lobes, with less frequent frontal lobe involvement. Higher blood pressure levels at presentation correlated with greater radiological extent of involvement. The most commonly reported symptoms were headache and visual disturbances. Conclusion: In this large single-center series, PRES predominantly affected women and was most commonly associated with pregnancy-related hypertensive disorders. Imaging findings primarily involved the occipital lobes, consistent with the classic posterior distribution. The observed relationship between blood pressure levels and lesion extent reinforces the central role of impaired autoregulation in PRES pathophysiology. Large case series such as this contribute to a better understanding of the clinical spectrum and radiological patterns of this potentially reversible condition.