Posterior reversible encephalopathy syndrome (PRES): diagnosis and management

Area of Science:

• Neurology
• Radiology
• Internal Medicine

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with diverse clinical presentations.
• It is characterized by brain edema, predominantly in posterior subcortical areas, visible on MRI.
• PRES is associated with various conditions including hypertension, pre-eclampsia, renal failure, and autoimmune disorders.

Purpose of the Study:

• To summarize the clinical presentation, radiological findings, triggering factors, and outcomes of Posterior Reversible Encephalopathy Syndrome (PRES).
• To highlight the implicated mechanisms and current treatment strategies for PRES.

Main Methods:

• Review of clinical symptoms such as visual disturbance, headache, seizures, and impaired consciousness.
• Magnetic Resonance Imaging (MRI) findings focusing on characteristic edema patterns.
• Analysis of common triggering factors and implicated pathophysiological mechanisms, particularly endothelial dysfunction.

Main Results:

• PRES manifests with a range of neurological deficits and characteristic posterior brain edema on MRI.
• Identified triggers include hypertension, pre-eclampsia/eclampsia, renal failure, cytotoxic agents, and autoimmune diseases.
• Endothelial dysfunction is a key implicated mechanism, though not fully understood.

Conclusions:

• PRES is a syndrome with varied clinical and radiological features, often triggered by specific medical conditions.
• While supportive treatment and management of underlying causes can lead to recovery, PRES carries risks of significant morbidity and mortality.
• Further research into the precise mechanisms may improve diagnostic and therapeutic approaches for PRES.