The Spectrum of Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome consists of acute to subacute symptoms which include seizures, encephalopathy, headaches, visual hallucinations or visual loss, and focal neurologic deficits in the setting of vasogenic brain edema. Both the clinical and radiographic findings are reversible in most, leading to a favorable neurologic prognosis. Less commonly, patients may have residual neurologic sequelae, often in cases with associated structural injury such as intracranial hemorrhage or stroke. A minority of patients develop a severe form, "malignant PRES" which can be fatal and may require intensive care unit care with aggressive therapies such as intubation, hyperosmolar therapy, ventriculostomy placement, or decompressive surgery.