Mohammad Athar Javed, Mohammad Shahid Hussain Sial, Sattam Lingawi, Adnan Alfi, Eman Lubbad.
Etiology of posterior Reversible Encephalopathy Syndrome (PRES)
Pak J Med Sci Apr - Jun 2005;21(2):149-54.
King Abdul Aziz Hospital & Oncology Center, Kingdom of Saudi Arabia
Objective: To study the causes and risk factors for the development of Posterior Reversible Encephalopathy Syndrome (PRES). Design: Prospective hospital based study over a period of five years from July 1999 to June2004. Patients and methods: Patients with clinical and neuroimaging features consistent with PRES were included in the study. All patients had detail clinical evaluation on presentation, and recovery from PRES. All had CT and/or MRI brain scan and other hematological and serological investigations to determine the most likely cause of the syndrome. Most patients also underwent follow up neuroimaging to demonstrate resolution of brain lesions. Results: Thirteen patients fulfilled the clinical and radiological features consistent with PRES. Seizures and altered conscious level were most common clinical manifestations. Main radiological feature on CT and /or MRI brain was extensive subcortical edema mainly confined to the posterior parieto-occipital lobes. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia were main causes of PRES in our study. We also found that this syndrome was more common in females than males. Clinically all patients recovered with control of blood pressure and discontinuation or reduction in dose of the offending drug within 2-7 days. There was almost complete resolution of radiological abnormalities within 2-4 weeks in patients who underwent follow up imaging. Conclusion: Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia are most common causes of posterior reversible encephalopathy syndrome with a greater predilection for females than males. Multiple factors may be contributory in some patients who develop PRES.
Category: Neurology
Keywords: Encephalopathy. Hypertension. Eclampsia. Seizure.
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