Understanding posterior reversible encephalopathy syndrome

Abstract

Posterior reversible encephalopathy syndrome is a characteristic clinical-radiographic syndrome with diverse and multifactorial causes. Symptoms include headache, altered mental status, seizures, nausea and vomiting, and vision abnormalities. The syndrome is treated by lowering BP, administering anticonvulsant medications, correcting metabolic abnormalities, and removing offending agents. Secondary complications include ischemia, hemorrhage, and cerebral infarction.

Posterior Reversible Encepalopathy Syndrome in A Child With Post Streptococcal Glomerulonephritis- A Rare Case Report

“…The another theory states that PRES is a result of cytotoxic edema occurring due to endothelial damage caused by circulating or direct toxic agents. 6 Most common cause of hypertension in children is renal parenchymal diseases,among them 10% of cases are complicated with hypertensive encephalopathy. 7 Hypertension encephalopathy with renal disease was first described in 1928.…”

Tumour-like presentation of atypical posterior reversible encephalopathy syndrome with prominent brainstem involvement

“…In fact, even if he had no history of hypertension, ophthalmological examination revealed a hypertensive retinopathy, hinting a chronic hypertensive insult. Sustained and persistent hypertension may exceed the brain vessels’ autoregulatory reserve, leading to vasodilatation and vasoconstriction with increased permeability of the blood–brain barrier and consequent vasogenic oedema 29 30. However, 15%–20% of patients with PRES are normotensive or hypotensive and, among patients who are hypertensive, less than 50% have a mean arterial blood pressure above the upper limit of cerebral blood flow autoregulation 29.…”

“…For example, cytokine release in immune disorders leads to increased vascular permeability, which possibly causes vasogenic oedema 29. It has been proposed that posterior cerebral circulation might be more vulnerable to a failure in autoregulation, due to less sympathetic innervation, thus explaining the frequent bilateral posterior involvement in PRES 29 30…”

“…Some authors recommend to treat ‘any degree of hypertension’ in the attempt to reduce the patient’s risk of complications 31. In the initial phase, blood pressure should be lowered no more than 25% in order to avoid ischaemic events 30. Labetalol and nircadipine are usually administered as first-line treatments in intensive care units; nitroglycerin should be avoided due to possible worsening of vasogenic oedema 29 36…”

Síndrome de Encefalopatia Posterior Reversível: Dois Casos Ilustrativos da Heterogeneidade Clínica

“…Caracteriza-se por combinações de encefalopatia, alterações do estado de consciência, crises epilépticas, alterações visuais, cefaleia e sinais focais, com evolução aguda/subaguda. [2][3][4][5] A heterogeneidade clínica não permite critérios de diagnóstico uniformes. 2,3,6 Apresentamos dois casos ilustrativos da variabilidade clínica desta síndrome, seguindo-se uma discussão sumária à luz do que sabemos sobre esta entidade.…”