Posterior reversible encephalopathy syndrome: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Posterior reversible encephalopathy syndrome MRI.jpg|thumb|Magnetic resonance image showing multiple cortico-subcortical areas of hyperintense signal involving the occipital and parietal lobes bilaterally and pons in a patient with posterior reversible encephalopathy syndrome]] | |||
*Focus on [[Altered Mental Status#Work-Up|altered mental status workup]], with PRES as diagnosis of exclusion | *Focus on [[Altered Mental Status#Work-Up|altered mental status workup]], with PRES as diagnosis of exclusion | ||
*MRI shows cerebral edema, especially in posterior circulation<ref name="Garg"/> | *MRI shows cerebral edema, especially in posterior circulation<ref name="Garg"/> | ||
Revision as of 17:48, 27 June 2017
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
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with anti-epileptic medications
- Hyponatremia
- INH toxicity
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Brain abscess
- Intracranial hemorrhage
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Barbiturate withdrawal
- Baclofen withdrawal
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia, hepatic failure, uremia
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Acute hydrocephalus
- Arteriovenous malformation
- Seizure with VP shunt
- Toxic ingestion (amphetamines, anticholinergics, cocaine, INH, organophosphates, TCA, salicylates, lithium, phenothiazines, bupropion, camphor, clozapine, cyclosporine, fluoroquinolones, imipenem, lead, lidocaine, metronidazole, synthetic cannabinoids, theophylline, Starfruit)
- Psychogenic nonepileptic seizure (pseudoseizure)
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
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