Posterior reversible encephalopathy syndrome (PRES)

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