Posterior reversible encephalopathy syndrome

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Background

Clinical Presentation

  1. Seizures
  2. Hypertension
  3. Encephalopathy/Altered Mental Status
  4. Visual Disturbances
  5. Vomiting
  6. Headache

Differential Diagnosis

  1. Eclampsia
  2. Vascular
    1. Hypertensive Encephalopathy
    2. CVA
    3. Intracranial Hemorrhage
    4. Central Venous Thrombosis
  3. Infectious
    1. Encephalitis
    2. Meningitis
  4. Metabolic
    1. Hepatic Encephalopathy
    2. Hyponatremia
    3. Porphyria
  5. Demyelinating Disorders
    1. SLE
  6. Psychiatric disorder

Workup

  • Focus on AMS workup, with PRES as diagnosis of exclusion

Diagnosis

  • MRI shows cerebral edema

Management

  1. Control Blood Pressure
  2. Discontinue Immunosupprants

Disposition

  • Admit

NB - Cardiac Transplant patients are at high risk, with relative hypertension and on immunosuppressants

See Also

Hypertensive Emergency Eclampsia

External Links

References

  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