From the Guidelines
PRES is a medical emergency that requires immediate identification and treatment of the underlying cause, typically involving blood pressure management and discontinuation of triggering medications, to prevent permanent brain damage and ensure complete recovery within days to weeks. The symptoms of Posterior Reversible Encephalopathy Syndrome (PRES) include headaches, visual disturbances, seizures, and altered consciousness, which develop rapidly due to brain swelling, primarily in the posterior regions 1.
Key Symptoms and Diagnostic Approaches
- Headache
- Visual disturbances
- Seizures
- Altered consciousness
- Magnetic resonance imaging (MRI) with fluid attenuated inversion recovery (FLAIR)-imaging is useful for confirming the diagnosis, while computerized tomography (CT) can help exclude intra-cerebral hemorrhage 1.
Treatment Strategies
- Identifying and removing the underlying cause, such as severe hypertension or certain medications, is crucial for effective treatment 1.
- Blood pressure management using IV medications like labetalol, nicardipine, or clevidipine in acute settings, followed by oral antihypertensives once stabilized, is a common approach.
- Seizures can be controlled with anticonvulsants such as levetiracetam or lorazepam for acute episodes.
- Discontinuation of triggering medications is essential when applicable. With prompt and proper treatment, most patients recover completely within days to weeks, but delayed treatment can lead to permanent brain damage, highlighting the importance of rapid diagnosis and intervention 1.
From the Research
Symptoms of Posterior Reversible Encephalopathy Syndrome (PRES)
- Visual disturbances, headache, vomiting, seizures, and altered consciousness are common symptoms of PRES 2
- Impairment in level of consciousness, seizures, visual disturbances, and focal neurological deficits are also observed in patients with PRES 3
- Headache, mental status alteration, seizures, and visual dysfunction are typical neurological symptoms of PRES 4
- Patients with PRES may present with varied forms of encephalopathy, focal neurologic symptoms, visual complaints, headache, and seizures 5
Treatment of Posterior Reversible Encephalopathy Syndrome (PRES)
- Management of PRES involves stabilization of the patient, adequate and prompt control of blood pressure, prevention of seizures, and timely treatment of any underlying trigger 2
- Control of blood pressure if elevated, and treatment of any underlying trigger are essential components of PRES treatment 6
- Parenteral anti-hypertensives with proper blood pressure monitoring are the mainstay of management for PRES 5
- Early identification and appropriate management of PRES can decrease morbidity and mortality without chronic neurologic sequelae 5
Diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES)
- Computed tomography (CT) and magnetic resonance imaging (MRI) are the recommended neuroimaging modalities for diagnosis of PRES 6
- Diffusion weighted MRI scans can help in early diagnosis and differentiation from other causes of altered sensorium 2
- Laboratory studies are primarily useful for excluding alternative diagnoses, while CT and MRI may demonstrate cerebral vasogenic edema 6
- Frequent neurological evaluations and neuroimaging examinations are required for both the diagnosis and assessment of PRES 4