Posterior Reversible Encephalopathy Syndrome: Tips for Diagnosis and Treatment

Abstract

Often described as a clinico-radiological entity, posterior reversible encephalopathy syndrome (PRES) is being increasingly diagnosed nowadays. However, mystery still surrounds its exact etiology. Though there are no standardized diagnostic criteria for this syndrome, there is a consistent feature associated with it: brain vasogenic edema in combination with neurotoxicity. The nonspecific nature of this condition leaves room for the diagnosis to be overlooked, leading to delays in providing appropriate treatment and unfavorable patient outcomes. PRES is associated with a variety of medical conditions including hypertension, eclampsia, autoimmune conditions, renal failure, sepsis, and an immunocompromised state, such as that secondary to the use of immunosuppressive therapy, human immunodeficiency virus (HIV), and organ transplants. Treatment by a multidisciplinary team and prompt identification and reversal of the underlying cause can lead to beneficial outcomes, as in the case we present in this report.

Posterior reversible encephalopathy syndrome in HIV-positive patients: A case report

“…We cannot know exactly the etiology of PRES, which is likely to be multifactorial. PRES has been identified in multiple conditions such as immunosuppressive therapy, sepsis, autoimmune conditions like lupus erythematosus [1]. Recently, PRES has been reported in a case of SARS-Cov2 infection [4].…”

“…Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic syndrome characterized by headache, vomiting, seizures, cortical blindness, altered mental status, and classic posterior cerebral edema on radiographic imaging [1,2].…”

“…It is diagnosed clinico-radiologically [1]. His mechanism is related to endothelial dysfunction and rupture of the bloodbrain barrier and thus extravasation of plasma and macromolecules resulting in vasogenic edema.…”

“…His mechanism is related to endothelial dysfunction and rupture of the bloodbrain barrier and thus extravasation of plasma and macromolecules resulting in vasogenic edema. Its reversibility depends on the underlying cause and the speed of diagnosis and treatment [1]. HIV infection has been associated with PRES syndrome either via endothelial inflammation or immune activation [2,3].…”

Posterior reversible encephalopathy syndrome in a child after burns: A case report and literature review

“…There are three main mechanisms. [13][14][15][16] The first mechanism is the 'hypoperfusion' theory. Ischaemia caused by cerebral vasospasm, increased sensitivity to pressor substances in blood circulation, decreased vasodilatory substances, and endothelial cell dysfunction lead to changes in vascular reactivity, causing vasospasm and reduced organ perfusion that can result in extravasation of the intravascular fluid.…”