Posterior reversible encephalopathy syndrome
Background
- Newly recognized, described in 1996[1]
- Caused by:
- Hypertensive Encephalopathy
- Immunosuppresion
- Uremia with HTN
Clinical Presentation
- Seizures
- Hypertension
- Encephalopathy/Altered Mental Status
- Visual Disturbances
- Vomiting
- Headache
Differential Diagnosis[2]
- Eclampsia
- Vascular
- Hypertensive Encephalopathy
- CVA
- Intracranial Hemorrhage
- Central Venous Thrombosis
- Infectious
- Metabolic
- Hepatic Encephalopathy
- Hyponatremia
- Porphyria
- Demyelinating Disorders
- Psychiatric disorder
Workup
- Focus on AMS workup, with PRES as diagnosis of exclusion
Diagnosis
- MRI shows cerebral edema, especially in posterior circulation[2]
Management
- Control Blood Pressure
- Discontinue Immunosupprants
Disposition
- Admit
NB - Cardiac Transplant patients are at high risk, with relative hypertension and on immunosuppressants