Case of the Month #41 Posterior Reversible Encephalopathy Syndrome (PRES)

Published 20/07/2023

How would you manage a patient with PRES?

A suggested clinical approach: 

  • Have a high index of suspicion if risk factors are present 

  • Radiology is key to confirming the diagnosis 

  • Seek and treat a precipitant 

  • Actively look for alternative diagnoses 

  • Reconsider the diagnosis if the clinical course does not fit the expected clinical course [6] 

 

Therapies 

  • Blood pressure management 

    • Individualised targets 
    • Lower MAP 20-25% in 2 hours [7] 

  • Neuroprotective measures 

  • Anti-convulsive therapy and EEG monitoring 

  • Steroids and diuresis are often used for vasogenic oedema 

  • Renal replacement therapy if required 

  • Ensure magnesium is corrected  

  • Withdraw potentially offending agents 

  • In SLE-related PRES:  corticosteroids and cyclophosphamide [1, 5]