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

Published 20/07/2023

Take Home Messages

  • There is a broad spectrum of presenting features in PRES.  The most common are hypertension, encephalopathy, seizures, headache and visual disturbance 

  • Suspect the diagnosis in patients with risk factors including any cause of hypertension, or endothelial dysfunction, or associated drugs 

  • There is not one diagnostic test, however the most strongly predictive test is by demonstrating vasogenic oedema on MRI 

  • Actively assess the differential and exclude alternative pathologies 

  • Treatment is supportive and includes blood pressure management, therapies to reduce cerebral oedema, and treating any precipitant 

  • Although most patients make a good recovery, some are left with long term neurological sequelae and PRES carries a 15% mortality