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01 November 2005

Clinical Spectrum and Critical Care Management of Posterior Reversible Encephalopathy Syndrome (PRES).

Pasquale Striano, Salvatore Striano, Fabio Tortora, Edoardo De Robertis, Daniela Palumbo, Andrea Elefante, Giuseppe Servillo

Med Sci Monit 2005; 11(11): CR549-553 :: ID: 430371

Abstract

Background: Posterior Reversible Encephalopathy (PRES) is characterizedby acute-onset headache, altered mental status, cortical blindness and seizures, with parietal-occipitalinvolvement. We report all cases of PRES diagnosed in our intensive care unit during the last 4 years,and evaluate their outcome in terms of the different medical treatments used. Even if usually reversible,PRES can sometimes result in death or irreversible neurological deficit, such as chronic epilepsy. Material/Methods:From January 2001 to January 2005, we identified 8 female patients with PRES. All patients underwentbasal and follow-up brain MRI. Patients referred to Epilepsy Center (about 3000 patients) were reviewedin order to identify subjects with a clinical history of PRES. These latter were clinically re-evaluatedand underwent video-EEG, MRI study and neuropsychological testing. Results: Of the 8 patients, 5 hadhypertensive encephalopathy during pregnancy; 2 had eclampsia during the postpartum period; 1 patientwith chronic renal failure developed symptoms after immunosuppressive treatment. In all patients but1, neurological and radiological abnormalities resolved after appropriate treatment. In addition, wefound 2 patients with temporal lobe epilepsy subsequent to a previous PRES. MRI revealed cortical-subcorticalmalacia in the parietal-occipital regions. Conclusions: The widespread use of MRI technology has madePRES familiar to many clinicians. Although PRES is reversible when treatment is instituted, delayed diagnosisand therapy can result in chronic neurological sequelae. The relationship between hypertensive encephalopathyand chronic epilepsy needs to be confirmed by longitudinal studies. Normalization of blood pressure andtreatment of seizures deserves particular attention.

Keywords: Brain Diseases - therapy, Blindness, Cortical - diagnosis, Electroencephalography, Epilepsy - therapy, Headache - therapy, Hypertensive Encephalopathy - therapy, Intensive Care, Magnetic Resonance Imaging, Mental Disorders - therapy, Seizures - therapy, Syndrome

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750