Posterior reversible encephalopathy syndrome: Difference between revisions
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**[[Renal Failure|Uremia]] with HTN | **[[Renal Failure|Uremia]] with HTN | ||
*Newly recognized, described in 1996<ref> Hinchey J, et al. "A reversible posterior leukoencephalopathy syndrome". PMID 8559202</ref> | *Newly recognized, described in 1996<ref> Hinchey J, et al. "A reversible posterior leukoencephalopathy syndrome". PMID 8559202</ref> | ||
==Clinical | |||
==Clinical Features<ref>Staykov D. "Posterior reversible encephalopathy syndrome". PMID 21257628</ref>== | |||
*[[Seizures]] | *[[Seizures]] | ||
*[[Hypertension]] | *[[Hypertension]] | ||
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{{Seizure DDX}} | {{Seizure DDX}} | ||
== | ==Diagnosis== | ||
*Focus on [[Altered Mental Status#Work-Up|AMS workup]], with PRES as diagnosis of exclusion | *Focus on [[Altered Mental Status#Work-Up|AMS 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"/> | ||
==Management== | ==Management== | ||
*[[Hypertensive Emergency#Treatment|Control Blood Pressure]] | *[[Hypertensive Emergency#Treatment|Control Blood Pressure]] | ||
*Discontinue | *Discontinue immunosupprants | ||
==Disposition== | ==Disposition== | ||
''Cardiac transplant patients are at high risk, with relative hypertension and on immunosuppressants'' | ''Cardiac transplant patients are at high risk, with relative hypertension and on immunosuppressants'' | ||
Revision as of 20:17, 11 June 2015
Background
- Caused by:
- Hypertensive Encephalopathy
- Immunosuppresion
- Uremia with HTN
- Newly recognized, described in 1996[1]
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)
Diagnosis
- Focus on AMS workup, with PRES as diagnosis of exclusion
- MRI shows cerebral edema, especially in posterior circulation[3]
Management
- Control Blood Pressure
- Discontinue immunosupprants
Disposition
Cardiac transplant patients are at high risk, with relative hypertension and on immunosuppressants
- 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