Reviewed and revised [last-modified]
OVERVIEW
Posterior reversible encephalopathy syndrome (PRES) is a syndrome of ‘cephalgia, convulsions, confusion, and vision loss’ (CCCV) typically in the context of severe hypertension
PATHOPHYSIOLOGY
The pathophysiology of PRES is poorly understood
- classically affects the posterior circulation of the brain
- combination of endothelial damage, impaired auto-regulation and increased cerebral perfusion pressure
- leads to hyperperfusion with resultant disruption of the blood brain barrier causing vasogenic oedema
CLINICAL MANIFESTATIONS
- headache
- seizures
- confusion
- vision loss
- hypertension
- risk factors
RISK FACTORS
- severe hypertension
- eclampsia
- renal failure
- immunosuppressive medications such as tacrolimus and cyclosporine
- hypomagnesemia
- post-transplant
INVESTIGATIONS
- MRI brain
- classically bilateral hyperintense densities in the parieto-occipital regions on T2 weighted images
- analogous finds may be seen on a CT head
MANAGEMENT
Specfic therapy
- Control hypertension
- Treat seizures
- Treat underlying cause
- e.g. IV magnesium and emergent delivery if pregnant
- Stop precipitating medications (e.g tacrolimus, cyclosporin)
PROGNOSIS
- partial to complete recovery is usual with appropriate treatment
- residual neurological and visual deficits may persist
References and Links
Journal articles
- Moratalla MB. Posterior Reversible Encephalopathy Syndrome. Emerg Med J. 2010 Jul;27(7):547 [pubmed]
FOAM and web resources
- Radiopaedia — Posterior Reversible Encephalopathy Syndrome (PRES)
Leave a Reply