Posterior reversible encephalopathy syndrome: Difference between revisions

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==Background==
==Background==
*Caused by:
*Abbreviation: PRES
**[[Hypertensive Emergency|Hypertensive Encephalopathy]]
*Risk factors include: [[malignant hypertension]], immunosuppression, [[eclampsia]]
**Immunosuppresion
*Poorly understood entity, but thought to be due to failure of cerebral auto-regulation in which the brain sees too high of systemic pressures leading to vasogenic edema
**[[Renal Failure|Uremia]] with HTN
*Somewhat of a misnomer as changes seen on MRI are not limited to the posterior fossa and symptoms are not always reversible
*Newly recognized, described in 1996<ref> Hinchey J, et al. "A reversible posterior leukoencephalopathy syndrome". PMID 8559202</ref>
**Renamed reversible posterior leukoencephalopathy syndrome (RPLS) by the American Academy of Neurology
==Clinical Presentation <ref>Staykov D. "Posterior reversible encephalopathy syndrome". PMID 21257628</ref>==
 
[[File:Posterior reversible encephalopathy syndrome MRI.jpg|thumb|Magnetic resonance image showing multiple cortico-subcortical areas of hyperdense signal involving the occipital and parietal lobes bilaterally and pons in a patient with posterior reversible encephalopathy syndrome]]
 
==Clinical Features<ref>Staykov D. "Posterior reversible encephalopathy syndrome". PMID 21257628</ref>==
*[[Seizures]]
*[[Seizures]]
*[[Hypertension]]
*[[Hypertension]]
*Encephalopathy/[[Altered Mental Status]]
*[[Encephalopathy]]/[[Altered Mental Status]]
*[[Acute Vision Loss (Noninflamed)|Visual Disturbances]]
*[[Acute Vision Loss (Noninflamed)|Visual Disturbances]]
*Vomiting
*[[Vomiting]]
*[[Headache]]
*[[Headache]]


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**[[Hepatic Encephalopathy]]
**[[Hepatic Encephalopathy]]
**[[Hyponatremia]]
**[[Hyponatremia]]
**Porphyria
**[[Porphyria]]
*Demyelinating Disorders
*Demyelinating Disorders (e.g. [[MS]])
**[[Systemic Lupus Erythematosus|SLE]]
**[[Systemic Lupus Erythematosus|SLE]]
*Psychiatric disorder
*Psychiatric disorder
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{{Seizure DDX}}
{{Seizure DDX}}


==Workup==
==Evaluation==
*Focus on [[Altered Mental Status#Work-Up|AMS workup]], with PRES as diagnosis of exclusion
*Focus on [[Altered Mental Status#Work-Up|altered mental status workup]], with PRES as diagnosis of exclusion
 
*[[brain MRI|MRI]] shows cerebral edema, especially in posterior circulation<ref name="Garg"/>
==Diagnosis==
*MRI shows cerebral edema, especially in posterior circulation<ref name="Garg"/>


==Management==
==Management==
*[[Hypertensive Emergency#Treatment|Control Blood Pressure]]
*[[Hypertensive Emergency#Treatment|Control Blood Pressure]]
*Discontinue Immunosupprants
*Discontinue immunosuppressants
 
==Disposition==
==Disposition==
*Admit
*Admit
''NB - Cardiac Transplant patients are at high risk, with relative hypertension and on immunosuppressants''
 
==See Also==
==See Also==
*[[Hypertensive Emergency]]
*[[Hypertensive emergency]]
*[[Eclampsia]]
*[[Eclampsia]]


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<references/>
<references/>


[[Category:Neuro]]
[[Category:Neurology]]

Revision as of 09:16, 16 May 2020

Background

  • Abbreviation: PRES
  • Risk factors include: malignant hypertension, immunosuppression, eclampsia
  • Poorly understood entity, but thought to be due to failure of cerebral auto-regulation in which the brain sees too high of systemic pressures leading to vasogenic edema
  • Somewhat of a misnomer as changes seen on MRI are not limited to the posterior fossa and symptoms are not always reversible
    • Renamed reversible posterior leukoencephalopathy syndrome (RPLS) by the American Academy of Neurology
Magnetic resonance image showing multiple cortico-subcortical areas of hyperdense signal involving the occipital and parietal lobes bilaterally and pons in a patient with posterior reversible encephalopathy syndrome

Clinical Features[1]

Differential Diagnosis[2]

Seizure

Evaluation

Management

Disposition

  • Admit

See Also

References

  1. Staykov D. "Posterior reversible encephalopathy syndrome". PMID 21257628
  2. 2.0 2.1 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