PRES (Posterior Reversible Encephalopathy Syndrome)

Etiology

  • Dysregulation of blood flow to brain, associated w/severe HTN and/or fluctuations in BP, renal failure, eclampsia, pre-eclampsia, autoimmune diseases, transplant/immunocsuppression
  • Severe hypertension (often fluctuating) overcomes brain's normal BP auto-regulation, resulting in vasogenic edema
  • Possible that BP isn't sole culprit, w/minority of cases having normal BP
  • Predilection for posterior circulation

Risk Factors

  • Hypertension, pregnancy (eclasmpsia, pre-eclampsia), renal failure, some auto-immune disorders.

Symptoms

  • Headache, confusion (hypertensive encephalopathy), seizures, focal neurological findings, visual disturbance (ischemia to occipital lobes)
  • Typically fully reverses when underlying cause(s) treated

Physical Exam Findings

  • Hypertension
  • Sometimes focal neurological findings

Tests