Posterior reversible encephalopathy syndrome in the setting of COPD: Proposed pathogenesis

Posterior reversible encephalopathy syndrome (PRES) has been associated with many conditions - particularly inflammatory, neoplastic and following organ failure. We submit that Chronic Obstructive Pulmonary Disease (COPD) is a significant predisposing factor for a number of these cases. Increased levels of circulating TNF-alpha, IL-1 and endothelin-1 (ET-1) are herein proposed as key mediators of this association. This theory builds on the central role of endothelial dysfunction in the pathogenesis of PRES. To our knowledge, no association of PRES and COPD has been made to date. We believe that it has practical implications: it suggests a lower threshold for MRI scans in certain patients. We suggest that the diagnosis of PRES should particularly be considered in ICU patients with typical signs (seizures, blindness, encephalopathy). Prompt recognition may lead to changes in management.