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Posterior reversible encephalopathy syndrome
From WikEM
Contents
Background
- Abbreviation: PRES
- Newly recognized, described in 1996[1]
- Cardiac transplant patients are at high risk, with relative hypertension and on immunosuppressants
Caused by
- Hypertensive Encephalopathy
- Immunosuppresion
- Uremia with hypertension
Clinical Features[2]
- Seizures
- Hypertension
- Encephalopathy/Altered Mental Status
- Visual Disturbances
- Vomiting
- Headache
Differential Diagnosis[3]
- Eclampsia
- Vascular
- Infectious
- Metabolic
- Hepatic Encephalopathy
- Hyponatremia
- Porphyria
- Demyelinating Disorders
- Psychiatric disorder
Seizure
- Epileptic seizure
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Intracranial hemorrhage
- Alcohol withdrawal
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Seizure with VP shunt
- Toxic ingestion
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
Evaluation
- Focus on altered mental status workup, with PRES as diagnosis of exclusion
- MRI shows cerebral edema, especially in posterior circulation[3]
Management
- Control Blood Pressure
- Discontinue immunosupprants
Disposition
- Admit
See Also
References
- ↑ Hinchey J, et al. "A reversible posterior leukoencephalopathy syndrome". PMID 8559202
- ↑ Staykov D. "Posterior reversible encephalopathy syndrome". PMID 21257628
- ↑ 3.0 3.1 Garg RK (January 2001). "Posterior leukoencephalopathy syndrome". Postgrad Med J 77 (903): 24–8. doi:10.1136/pmj.77.903.24. PMC 1741870. PMID 11123390
Authors
Jonathan Osgood, Ross Donaldson, Daniel Ostermayer, Neil Young
