From the Guidelines
Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition characterized by temporary swelling in the posterior regions of the brain, particularly the occipital and parietal lobes, and its symptoms include headache, visual disturbances, seizures, and altered mental status, as noted in the 2019 European Heart Journal study 1. The symptoms of PRES can be diverse and may include:
- Sudden onset headache
- Confusion
- Altered mental status
- Seizures
- Visual disturbances such as blurred vision, visual hallucinations, or even temporary blindness
- Nausea
- Vomiting
- Impaired consciousness ranging from drowsiness to coma These symptoms can develop in the setting of severe hypertension, certain medications, eclampsia in pregnant women, kidney disease, or autoimmune disorders, as mentioned in the study 1. The diagnosis of PRES is typically made using brain MRI, which shows characteristic white matter edema in the posterior brain regions, as described in the 2019 study 1. The key to managing PRES is prompt identification and treatment of the underlying cause, which often involves controlling blood pressure, discontinuing offending medications, and providing supportive care, in order to prevent permanent brain damage and improve patient outcomes, as implied by the study 1.
From the Research
Definition and Symptoms of Posterior Reversible Encephalopathy Syndrome (PRES)
- Posterior Reversible Encephalopathy Syndrome (PRES) is an acute neurotoxic syndrome characterized by a spectrum of neurological and radiological features from various risk factors 2.
- Common neurological symptoms of PRES include:
- PRES is typically characterized by bilateral reversible vasogenic edema of the subcortical white matter in the parieto-occipital region on neuroimaging 4, 6.
Triggering Factors and Radiographic Findings
- Common triggering factors for PRES include:
- Radiographic findings of PRES include:
- Bilateral subcortical vasogenic edema predominantly affecting the parieto-occipital regions
- Atypical features such as involvement of other regions, cortical involvement, restricted diffusion, hemorrhage, and contrast enhancement 2.
Treatment and Prognosis
- Treatment of PRES is supportive and involves correcting the underlying cause and managing associated complications, such as seizures 5.
- Early detection and treatment of PRES are key for a rapid recovery and good prognosis 4, 6.
- Although most patients recover, PRES is not always reversible and may be associated with considerable morbidity and even mortality 2, 5.