From the Guidelines
The management of Posterior Reversible Encephalopathy Syndrome (PRES) should focus on immediate discontinuation of offending medications, correction of electrolytes, and symptomatic treatment with benzodiazepines, as well as stringent control of blood pressure, particularly in hypertensive patients. The treatment approach for PRES is primarily symptomatic and aims to address the underlying cause of the condition 1. Key aspects of management include:
- Discontinuation of medications known to induce PRES, such as ifosfamide 1
- Correction of electrolyte imbalances, if present 1
- Symptomatic treatment with benzodiazepines for seizure management 1
- Stringent control of blood pressure to prevent further cerebral injury 1
- Supportive care, including airway protection, maintaining adequate oxygenation, and preventing complications in unconscious patients
In terms of blood pressure management, it is crucial to lower blood pressure gradually to avoid cerebral hypoperfusion 1. The use of intravenous antihypertensive medications, such as labetalol or nicardipine, may be necessary to achieve this goal. Seizure management with antiepileptic drugs, such as levetiracetam, may also be indicated in patients experiencing seizures 1. However, long-term antiepileptic therapy is typically unnecessary, as seizures are usually self-limited. Overall, prompt recognition and treatment of PRES are essential to prevent permanent neurological damage and improve patient outcomes 1.
From the Research
Management Approach for Posterior Reversible Encephalopathy Syndrome (PRES)
The management approach for Posterior Reversible Encephalopathy Syndrome (PRES) involves several key components, including:
- Normalization of blood pressure to prevent further neurological damage 2
- Treatment of seizures, which can be a symptom of PRES, using antiepileptic drugs 2, 3
- Withdrawal or adjustment of immunosuppressive therapy, which can be a precipitant of PRES 4, 3
- Management of underlying medical conditions, such as hypertensive encephalopathy or eclampsia 2, 5
Treatment of Seizures in PRES
Seizures are a common symptom of PRES, and their treatment is crucial to prevent further neurological damage. The use of antiepileptic drugs, such as phenytoin or levetiracetam, has been recommended for seizure prophylaxis in patients with traumatic brain injury 6. Similarly, in patients with PRES, antiepileptic drugs can be used to control seizures and prevent their recurrence.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of PRES are essential to prevent chronic neurological sequelae. Delayed diagnosis and therapy can result in irreversible neurological damage, such as chronic epilepsy 2. Therefore, it is crucial to recognize the symptoms of PRES, including headache, altered mental status, and seizures, and to initiate treatment promptly.
Role of Imaging Studies in Diagnosis
Imaging studies, such as magnetic resonance imaging (MRI), play a crucial role in the diagnosis of PRES. MRI can show characteristic changes in the brain, including white matter edema and cortical-subcortical malacia in the parietal-occipital regions 2, 4. These changes can help confirm the diagnosis of PRES and guide treatment.