PRES

OVERVIEW

Posterior reversible encephalopathy syndrome (PRES) is a syndrome of ‘cephalgia, convulsions, confusion, and vision loss’ (CCCV) typically in the context of severe hypertension

PATHOPHYSIOLOGY

The pathophysiology of PRES is poorly understood

  • classically affects the posterior circulation of the brain
  • combination of endothelial damage, impaired auto-regulation and increased cerebral perfusion pressure
  • leads to hyperperfusion with resultant disruption of the blood brain barrier causing vasogenic oedema

CLINICAL MANIFESTATIONS

  • headache
  • seizures
  • confusion
  • vision loss
  • hypertension
  • risk factors

RISK FACTORS

  • severe hypertension
  • eclampsia
  • renal failure
  • immunosuppressive medications such as tacrolimus and cyclosporin
  • hypomagnesemia
  • post-transplant

INVESTIGATIONS

  • MRI brain
    • classically bilateral hyperintense densities in the parieto-occipital regions on T2 weighted images
  • analogous finds may be seen on a CT head

MANAGEMENT

Specfic therapy

  • Control hypertension
  • Treat seizures
  • Treat underlying cause
    • e.g. IV magnesium and emergent delivery if pregnant
  • Stop precipitating medications (e.g tacrolimus, cyclosporin)

PROGNOSIS

  • partial to complete recovery is usual with appropriate treatment
  • residual neurological and visual deficits may persist

References and Links

Journal articles

  • Moratalla MB. Posterior Reversible Encephalopathy Syndrome. Emerg Med J. 2010 Jul;27(7):547 ]PMID 20584957]

FOAM and web resources


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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