Posterior reversible encephalopathy syndrome
|Posterior reversible encephalopathy syndrome|
|Classification and external resources|
Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is a syndrome characterized by headache, confusion, seizures and visual loss. It may occur due to a number of causes, predominantly malignant hypertension, eclampsia and some medical treatments. On magnetic resonance imaging (MRI) of the brain, areas of edema (swelling) are seen. The symptoms tend to resolve after a period of time, although visual changes sometimes remain. It was first described in 1996.
Several factors appear to play a role in the pathogenesis of PRES, including immunosuppressive therapy, renal failure, eclampsia, severe high blood pressure, and lupus. Low magnesium levels can augment PRES.
Signs and symptoms
The diagnosis is typically made clinically, with supportive findings on magnetic resonance imaging of the brain; this may show hyperintensities on T2-weighed imaging. Three different patterns have been described on MRI imaging. Cerebral angiography may provide a more definite diagnosis.
The treatment of PRES depends on the underlying cause. For instance, if the main problem is high blood pressure, blood pressure control will accelerate the resolution of the abnormalities. If the likely cause is medication, the withdrawal of the drug in question is needed.
Many cases resolve within 1–2 weeks of controlling the blood pressure and eliminating the enciting factor. However, long-lasting or even permanent neurologic dysfunction may remain. Though uncommon, death may occur with progressive swelling of the brain (cerebral edema) or a bleed in the brain (intracerebral hemorrhage).
The incidence of PRES is not currently known. Case reports suggest that there is no age predilection, with cases reported in people ages 2 to 90 years old. It may be somewhat more common in females.
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