From the Research
Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition that requires immediate attention and treatment to prevent morbidity and mortality, and the primary treatment involves addressing the underlying cause, which is typically severe hypertension, preeclampsia, certain medications, or autoimmune disorders, as supported by the most recent study 1. The syndrome is characterized by headache, confusion, seizures, and visual disturbances due to brain swelling in the posterior regions. According to a recent study 2, the most common symptoms of PRES include headaches, altered mental status, seizures, visual disturbances, nausea or vomiting, and focal neurological deficits.
Key Points to Consider
- The frequent predisposing factors include hypertension, renal diseases, immunosuppressant drugs, and chemotherapy/chemoradiotherapy, as reported in a study with a large sample size 2.
- MRI features are mainly characterized by vasogenic edema in central zones always accompanied by typical regions, as described in a study on the clinical and MRI features of PRES 2.
- Immediate blood pressure control is essential, often using IV medications like labetalol, nicardipine, or hydralazine in a monitored setting, as recommended in a practical guide to PRES diagnosis and management 1.
- Seizures should be managed with anticonvulsants such as levetiracetam (500-1000 mg twice daily) or phenytoin (loading dose of 15-20 mg/kg), as suggested in a study on the treatment of PRES 3.
- Removal of offending medications and supportive care are also crucial, as emphasized in a study on the importance of prompt treatment in PRES 1.
Treatment and Management
- The primary goal of treatment is to address the underlying cause and manage associated complications, such as seizures, as recommended in a recent study 1.
- Regular neurological monitoring and follow-up imaging are important to confirm resolution of brain edema, as suggested in a study on the diagnosis and management of PRES 1.
- Most patients recover completely within days to weeks with prompt treatment, though some may have residual neurological deficits, as reported in a study on the outcomes of PRES patients 2.