Posterior reversible encephalopathy syndrome

Background

• Newly recognized, described in 1996
• Caused by:
  • Hypertensive Encephalopathy
  • Immunosuppresion
  • Uremia with HTN

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, especially in posterior circulation

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