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Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years?
  1. Bo Gao1,
  2. Cui Lyu2,
  3. Alexander Lerner3,
  4. Alexander M McKinney4
  1. 1 Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
  2. 2 Department of Neurology, Yantaishan Hospital of Yantai City, Yantai, Shandong, China
  3. 3 Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  4. 4 Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Bo Gao, Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, China; gygb2004{at}


Over two decades have passed since posterior reversible encephalopathy syndrome (PRES) was first described in 1996. It has becoming increasingly recognised because of improved and more readily available imaging modality. The exact pathophysiological mechanism is not completely understood and remains controversial at present. Precise diagnosis is essential to guide prompt, proper management. Our ability of differentiating it from other acute neurological disorders is likely to improve as we learnt more about the spectrum of this entity in the last 20 years. We emphasise the importance of recognising its diagnostic criteria and biomarker, which would be of great relevance to either outcome evaluation or study design. PRES has a favourable prognosis generally, but neurological sequelae and even fatalities can occur, especially in severe forms that might cause substantial morbidity and even mortality, particularly when the syndrome is complicated by intracranial haemorrhage or brain infarction. In this review, the pathophysiology, approach to diagnosis, some controversies as to the prognosis, as well as the future research direction of PRES are described.

  • posterior reversible encephalopathy syndrome
  • pathophysiology
  • diagnosticcriteria
  • imaging biomarker
  • prognosis

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  • BG and CL contributed equally.

  • Contributors BG and CL conceived the idea for the article and wrote the first draft. All authors revised the manuscript critically for important intellectual content and gave final approval of the version to be published. BG and CL contribute equally to the review and considered as the co-first author.

  • Funding BG reports research grant from National Natural Science Foundation of China (NSFC, Grant No. 81471645) and Shandong Provincial Key Research & Development Project (2015GSF118185).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note References 60 onwards can be found as an online supplementary reference file.

  • Correction notice Since this paper was first published online Shandong Provincial Key Research & Development Project has been added as a funder.