Posterior reversible encephalopathy in the intensive care unit

Area of Science:

• Neurology
• Critical Care Medicine

Background:

• Posterior reversible encephalopathy syndrome (PRES) is increasingly diagnosed in intensive care units (ICUs).
• PRES is associated with various conditions including blood pressure fluctuations, eclampsia, autoimmune diseases, transplantation, renal failure, and exposure to certain drugs.
• The underlying pathophysiology is thought to involve endothelial dysfunction, though specific mechanisms vary.

Purpose of the Study:

• To highlight the growing incidence and diagnostic utility of PRES in critical care settings.
• To emphasize the importance of recognizing the full spectrum of PRES manifestations.
• To underscore the need for prompt identification and management of inciting factors.

Main Methods:

• Clinical diagnosis based on characteristic neurologic symptoms.
• Brain imaging, particularly MRI, showing bilateral vasogenic edema, especially in parieto-occipital regions.
• Review of clinical presentations and known triggers associated with PRES.

Main Results:

• PRES presents with acute neurologic symptoms and is linked to various ICU-relevant conditions.
• Bilateral vasogenic edema on imaging is a key diagnostic indicator.
• While often reversible, PRES can lead to severe or fatal outcomes if not managed promptly.

Conclusions:

• PRES is a frequent toxic-metabolic encephalopathy in the ICU.
• Familiarity with the diverse clinical and radiographic features of PRES is crucial for clinicians.
• Early recognition and elimination of causative factors significantly improve patient outcomes.