posterior reversible encephalopathy syndrome (PRES)
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Etiology
- hypertension
- cytotoxic drugs
- sepsis
- thrombotic thrombocytopenic purpura
- preeclampsia/eclampsia
- obstructive uropathy[2]
- comorbidities
- renal failure in 57% of patients
- autoimmune disease in 45% of patients
Pathology
- endothelial dysfunction (putative)
- breakdown in cerebral autoregulation (putative)
Clinical manifestations
- acute neurological changes
- hypertension
- acute rise in blood pressure (mean = 191/104 mm Hg)
- clinically reversible
Laboratory
Diagnostic procedures
- ophthalmoscopy may reveal Flame hemorrhages & papilledema
- lumbar puncture[2]
- ultrasound of bladder for post-void residual volume
- renal ultrasound
Radiology
- magnetic resonance imaging
- focal vasogenic edema
- radiological reversibility
- parietal-occipital involvement (~100%)
- frontal lobe (77%)
- temporal lobe (64%)
- cerebellum (53%)
- basal ganglia ( 34%)
- brainstem (27%
Management
- supportive, treat signs/symptoms
- prognosis
- resolution in ~90% of cases
More general terms
References
- ↑ Fugate JE et al. Posterior reversible encephalopathy syndrome: Associated clinical and radiologic findings. Mayo Clin Proc 2010 May; 85:427. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20435835 <Internet> http://dx.doi.org/10.4065/mcp.2009.0590
- ↑ 2.0 2.1 2.2 2.3 Blum SM, Prust ML, Patel R et al Stream of Consciousness. N Engl J Med 2018; 378:1336-1342. April 5, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29617591 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcps1714950