From the Research
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by reversible subcortical vasogenic edema that primarily affects the posterior areas of the brain, as recently described in a case report and literature review published in 2025 1.
Key Characteristics of PRES
- Temporary swelling in the posterior regions of the brain, particularly the parietal and occipital lobes
- Symptoms include headache, confusion, seizures, visual disturbances, and occasionally focal neurological deficits
- Usually triggered by sudden increases in blood pressure, certain medications (such as immunosuppressants), autoimmune disorders, and kidney disease
Diagnosis and Treatment
- Brain MRI is the diagnostic test of choice, showing characteristic white matter edema in posterior brain regions
- The primary treatment involves addressing the underlying cause, especially controlling blood pressure with medications such as labetalol, nicardipine, or hydralazine administered intravenously in acute settings, as highlighted in a narrative review published in 2021 2
- If medication-induced, the offending agent should be discontinued or reduced
Prognosis and Outcome
- Most patients recover completely within days to weeks with prompt treatment
- Delayed diagnosis can lead to permanent brain damage
- A systematic literature review published in 2020 emphasized the importance of early recognition and treatment of PRES to prevent long-standing morbidity and mortality 3
Clinical Considerations
- Clinicians should maintain a high index of suspicion for PRES in patients receiving monoclonal anti-CD20 antibody therapies, immunosuppressants, and corticosteroids
- A review article published in 2020 discussed the challenges in managing PRES caused by cytotoxic agents, highlighting the need for careful consideration of the risks and benefits of discontinuing these agents 4