Journal Article

Posterior Reversible Encephalopathy Syndrome

Gewirtz, Alexandra N., Gao, Virginia, Robbins, Matthew S., Parauda, Sarah C.

2021

Overview

Purpose of Review This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion. Recent Findings COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1–4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. Summary PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.

• Publisher: Springer US,Springer Nature B.V
• Subject: Acute Chest Syndrome - epidemiology / Aminolevulinic Acid - analogs & derivatives / Anemia, Sickle Cell - epidemiology / Autoimmune Diseases - epidemiology / Blood-Brain Barrier - metabolism / Brain Edema - diagnostic imaging / Brain Edema - physiopathology / Cerebrovascular Circulation - physiology / COVID-19 / COVID-19 - epidemiology / Cytokines - metabolism / Eclampsia - epidemiology / Edema / Endothelium - physiopathology / Female / Headache - physiopathology / Headaches / Homeostasis - physiology / Humans / Hypertension - physiopathology / Internal Medicine / Magnetic Resonance Imaging / Medicine / Medicine & Public Health / Neurological disorders / Pain Medicine / Posterior Leukoencephalopathy Syndrome - diagnostic imaging / Posterior Leukoencephalopathy Syndrome - epidemiology / Posterior Leukoencephalopathy Syndrome - physiopathology / Posterior Leukoencephalopathy Syndrome - therapy / Pre-Eclampsia - epidemiology / Pregnancy / Prognosis / Renal Insufficiency - epidemiology / SARS-CoV-2 / Secondary Headache (M Robbins / Secondary Headache (M Robbins, Section Editor) / Section Editor / Seizures - physiopathology / Severe acute respiratory syndrome coronavirus 2 / Topical Collection on Secondary Headache / Vasospasm, Intracranial - physiopathology / Vision Disorders - physiopathology