Drugs associated with posterior reversible encephalopathy syndrome, a worldwide signal detection study

Posterior reversible encephalopathy syndrome associated with antibiotic therapy: a case report and systematic review

“…majority of patients show complete or almost complete clinical and radiological recovery after prompt discontinuation of the drug; 5) may not be antibiotic or pathogen specific, although metronidazole and fluoroquinolones were the most commonly reported antibiotics. Overall, our findings are in line with previous literature on the pathophysiological and clinical features of PRES; indeed, previous studies reported also on the female predominance in drug-associated PRES cases [2]. Further, the elevation of arterial BP is thought to be the driving pathological mechanism in most cases of PRES, leading to cerebral hyper-perfusion [1].…”

“…Non-original records, studies with no full text available and articles in languages other than English were excluded. In addition, we included only studies that reported: 1) diagnosis of PRES [1,2]; 2) recent administration of antibiotics and medical indication thereof; 3) information on symptoms and vital parameters at clinical onset; 4) at least one neuroimaging marker supporting the diagnosis of PRES [1,2].…”

“…Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome associated with subcortical vasogenic oedema, particularly in the posterior parieto-occipital regions. Typical clinical manifestations include non-specific symptoms such as headache and dizziness, but also more severe features such as altered consciousness, visual impairment and seizures [1,2]. The pathophysiology of PRES is not fully understood yet but appears to be related to dysregulation of cerebral blood flow, cytokine release, disruption of the blood-brain barrier.…”

“…The pathophysiology of PRES is not fully understood yet but appears to be related to dysregulation of cerebral blood flow, cytokine release, disruption of the blood-brain barrier. This may result in endothelial damage and fluid leakage [2]. The posterior regions of the brain appear to be particularly susceptible to hyperperfusion and vasogenic oedema because of the relatively reduced sympathetic innervation in the posterior fossa, and consequently lower Alexander Mensch and Samir Abu-Rumeileh shared last coauthorship.…”

“…In addition, the development of PRES may be secondary to the administration of drugs. A recent study based on the World Health Organization (WHO) global pharmacovigilance database identified 152 drugs significantly associated with PRES, most of which were antineoplastic, immunomodulatory, and antimicrobial agents [2]. These agents might cause injury or inhibition of endothelial cell proliferation [2] (Fig.…”