PRES
Posted On February 13, 2020
AKA
- Posterior reversible encephalopathy syndrome (PRES)
- Reversible posterior cerebral edema syndrome
- Posterior leukoencephalopathy syndrome
- Hyperperfusion encephalopathy
- Brain capillary leak syndrome
Symptoms
- headache
- altered consciousness/confusion
- visual disturbance
- seizure
MRI
- calcarine and paramedian parts of the occipital lobe are usually spared, helping to distinguish RPLS from bilateral posterior cerebral infarctions
- Involvement of the cerebellum and brainstem is common
- abnormalities primarily affect the subcortical white matter, the cortex and basal ganglia may be involved
Etiology
- Most often occurs in the setting of
- hypertensive crisis
- preeclampsia
- cytotoxic immunosuppressive therapy (most common is cyclosporine)
- however, many other clinical settings are described.
Treatment
- Lower bp with nicardipine or labetolol
- withdraw or lower cytotoxic drug
- Treat seizure
- For partum or postpartum patient: treat as eclampsia
- Most patient recover in 2 weeks.