Reversible Encephalopathy Syndromes and Neuroimaging Diagnostics

Reversible encephalopathy syndromes encompass a spectrum of acute neurological disorders characterised by transient dysfunction of the cerebral cortex, variable clinical presentations and typically reversible imaging findings. The most widely recognised entity in this group is posterior reversible encephalopathy syndrome (PRES), which manifests with seizures, headache, visual disturbances and altered consciousness. A related condition, reversible cerebral vasoconstriction syndrome (RCVS), often presents with sudden-onset “thunderclap” headaches and may be complicated by ischaemic or haemorrhagic stroke. Both syndromes share overlapping risk factors such as severe hypertension, cytotoxic agents, eclampsia and autoimmune disorders, suggesting common pathophysiological pathways involving endothelial injury and dysregulation of cerebral blood flow. Neuroimaging plays a central role in diagnosis, with magnetic resonance imaging (MRI) revealing characteristic patterns of vasogenic oedema in PRES and segmental arterial narrowing in RCVS. Advanced techniques, including diffusion-weighted imaging, perfusion studies and high-resolution vessel wall imaging, have refined the detection of atypical lesion distributions, blood–brain barrier disruption and microvascular changes. Together, these modalities aid in early recognition, guide therapeutic interventions and support prognostic assessment, underscoring the global significance of neuroimaging in managing these potentially reversible conditions.

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Reversible Encephalopathy Syndromes and Neuroimaging Diagnostics publication trend

The graph below shows the total number of articles in reversible encephalopathy syndromes and neuroimaging diagnostics across all publications each year (not limited to Nature Index journals).

Technical terms

Posterior reversible encephalopathy syndrome (PRES): An acute neurotoxic state characterised by vasogenic oedema predominantly in posterior cerebral regions and associated neurological symptoms that are usually reversible.

Reversible cerebral vasoconstriction syndrome (RCVS): A disorder marked by transient constriction of cerebral arteries, severe headache and risk of stroke, resolving within weeks to months.

Vasogenic oedema: Extracellular accumulation of fluid due to disruption of the blood–brain barrier, visible as hyperintensity on T2-weighted MRI sequences.

Dynamic cerebral autoregulation: The mechanism by which cerebral blood vessels adjust diameter rapidly to maintain stable perfusion in response to systemic blood pressure fluctuations.

Blood–brain barrier: A selective permeability barrier formed by endothelial tight junctions that protects neural tissue from circulating toxins while regulating fluid and solute exchange.

References

1. Association between impaired dynamic cerebral autoregulation and BBB disruption in reversible cerebral vasoconstriction syndrome. The Journal of Headache and Pain (2023).
2. Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome. Frontiers in Neurology (2020).
3. Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations. Frontiers in Neurology (2020).