The syndrome of reversible back encephalopathy is now more often recognized than in the past because of a wide spreading of brain imaging techniques, above all MNR. Some researchers at Mayo Clinic have presented a series of 113 patients affected by this syndrome, hospitalized between 1999 and 2009. Inclusion criteria were: 1) acute neurological manifestations, such as convulsions, headache, encephalopathy, vision disorders, focal deficiencies; 2) focal edema shown through imaging; 3) clinical or radiological reversibility. The most frequent primary causes were hypertension, intake of cytotoxic drugs, sepsis, thrombocytopenic purpura, eclampsia and preeclampsia. Renal failure was present in 57% of subjects, while an autoimmune disease was present in 45% of them. Most patients have presented an acute increase in blood pressure (with an average peak of 191/104 mmHg) and, in most cases, convulsive episodes (74%). At MNR, almost everyone had a parieto-occipital involvement, while in 77% of cases, there has been an involvement of the frontal lobe, of the temporal lobe in 64% of cases, of the cerebellum in 53% of cases, of the basic ganglia in 34% of cases and of the brainstem in 27% of cases. During follow-up, there has been an improvement or a recovery in 88% of cases.
When there are patients with acute neurological symptoms, one must always think to a syndrome of back encephalopathy, especially in subjects at risk. We should keep in mind also localization, which is not necessarily always in the back side, and the fact that some neurological deficiencies can also be irreversible.
