From the Research
Posterior Reversible Encephalopathy Syndrome (PRES) should be diagnosed and managed promptly with a focus on controlling blood pressure, treating seizures, and discontinuing offending medications, as outlined in the most recent study from 2022 1.
Diagnosis of PRES
PRES is characterized by variable symptoms, including visual disturbances, headache, vomiting, seizures, and altered consciousness, as described in a study from 2020 2. The diagnosis requires MRI imaging, which typically shows symmetrical white matter abnormalities suggestive of edema in the posterior parieto-occipital regions of the cerebral hemispheres.
Management of PRES
The management of PRES is chiefly concerned with stabilization of the patient, adequate and prompt control of blood pressure, prevention of seizures, and timely caesarean section in obstetric cases with pre-eclampsia/eclampsia, as noted in a study from 2020 2.
- Blood pressure should be reduced gradually by 25% within the first few hours using intravenous antihypertensives.
- If seizures occur, they should be treated with benzodiazepines followed by levetiracetam or another antiepileptic.
- Offending medications, particularly calcineurin inhibitors like tacrolimus or cyclosporine, should be discontinued or doses reduced.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of PRES are crucial to prevent further complications and improve outcomes, as emphasized in a study from 2022 1. Delayed diagnosis and treatment may result in death or irreversible neurological sequelae, as noted in a study from 2007 3.
Pathophysiology of PRES
The pathophysiology of PRES involves endothelial dysfunction and breakdown of the blood-brain barrier, leading to vasogenic edema, which explains why prompt treatment of the underlying cause typically results in complete resolution, as described in a study from 2018 4.