"Recurrent" posterior reversible encephalopathy syndrome: report of 3 cases--PRES can strike twice!

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Jon M Sweany1, Walter S Bartynski, John F Boardman

  • 1Department of Medicine, UPMC Shadyside Hospital, PA, USA.

Journal of Computer Assisted Tomography
|January 30, 2007
PubMed

Insights

Recurrent posterior reversible encephalopathy syndrome (PRES) occurred in 3.8% of patients, often linked to infections and endothelial injury. These cases highlight the potential for severe outcomes, including multiple organ dysfunction syndrome.

Area of Science:

  • Neurology
  • Nephrology
  • Hematology

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by headaches, seizures, and altered consciousness.
  • Recurrence of PRES is uncommon but associated with significant morbidity.

Observation:

  • This retrospective review analyzed 78 patients, identifying 3 (3.8%) with recurrent PRES.
  • Recurrent cases were associated with underlying conditions such as sickle cell disease, autoimmune diseases, and bone marrow transplantation.

Findings:

  • Infection (bacterial or viral) was implicated in both episodes of PRES in all affected patients.
  • Evidence of endothelial injury, including schistocyte formation and elevated lactate dehydrogenase, was consistently observed.
  • All patients experienced multiple organ dysfunction syndrome during their hospitalizations.

Implications:

  • Infections and endothelial dysfunction are critical factors in recurrent PRES.
  • Prompt recognition and management of underlying conditions and potential triggers are crucial for improving patient outcomes.
  • Further research into the mechanisms of PRES recurrence and targeted therapies is warranted.

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