Posterior reversible encephalopathy syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Abbreviation: PRES | *Abbreviation: PRES | ||
*Risk factors include: malignant hypertension, immunosuppression, eclampsia | *Risk factors include: [[malignant hypertension]], immunosuppression, [[eclampsia]] | ||
[[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]] | [[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]] | ||
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*[[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]] | ||
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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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==Evaluation== | ==Evaluation== | ||
*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"/> | *[[brain MRI|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 immunosuppressants | ||
==Disposition== | ==Disposition== | ||
Revision as of 00:21, 2 October 2019
Background
- Abbreviation: PRES
- Risk factors include: malignant hypertension, immunosuppression, eclampsia
Clinical Features[1]
Differential Diagnosis[2]
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[2]
Management
- Control Blood Pressure
- Discontinue immunosuppressants
Disposition
- Admit