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Posterior reversible encephalopathy syndrome.

Dimitre Staykov1, Stefan Schwab

  • 1Neurology Department, University of Erlangen-Nuremberg, Germany. dimitre.staykov@uk-erlangen.de

Journal of Intensive Care Medicine
|January 25, 2011
PubMed
Summary

Posterior reversible encephalopathy syndrome (PRES) presents with neurological symptoms and characteristic brain imaging findings. Prompt diagnosis and management, particularly of hypertension and seizures, are crucial for a favorable prognosis and to prevent permanent neurological damage.

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Area of Science:

  • Neurology
  • Radiology
  • Intensive Care Medicine

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is a neurological condition.
  • It is characterized by headache, altered mental status, visual disturbances, and seizures.
  • Radiological findings often include posterior cerebral edema, but atypical presentations are common.

Purpose of the Study:

  • To summarize the key features, associated conditions, and management of PRES.
  • To emphasize the importance of early recognition and intervention for optimal patient outcomes.
  • To highlight the role of intensivists in managing PRES.

Main Methods:

  • Review of clinical and radiological characteristics of PRES.
  • Identification of common and atypical imaging findings.
  • Analysis of associated conditions and risk factors.
  • Discussion of current management strategies and pathophysiology.

Main Results:

  • PRES typically involves posterior cerebral edema, but anterior, deep white matter, and brainstem involvement can occur.
  • Commonly associated conditions include toxemia of pregnancy, transplantation, immunosuppression, chemotherapy, autoimmune diseases, and hypertension.
  • Vasoconstriction is frequently observed on vascular imaging.
  • The pathophysiology remains incompletely understood.

Conclusions:

  • PRES requires prompt diagnosis and management in a neurointensive care unit setting.
  • Treatment focuses on managing severe hypertension, seizures, and withdrawing causative agents.
  • Early intervention leads to a generally benign prognosis with complete symptom reversal.
  • Delayed diagnosis and treatment can result in permanent neurological deficits.