The Reversible Posterior Encephalopathy Syndrome is an intriguing condition associated with vasogenic edema in the brain.


Synonyms: Reversible Posterior Leukoencephalopathy Syndrome, Posterior Reversible Encephalopathy Syndrome (PRES)


Predisposing conditions:

(1) severe and/or rapidly progressive hypertension

(2) eclampsia of pregnancy

(3) immunosuppressant therapy (cyclosporine, tacrolimus, etc)

(4) acute intermittent porphyria


Clinical findings:

(1) headache

(2) decreased alertness and/or mental functioning (confusion, lethargy, somnolence; may alternate with agitation and restlessness

(3) seizures

(4) visual loss, including blurred vision, hemianopia, visual neglect or cortical blindness

(5) vomiting

(6) reversibility with control of precipitating factor(s)


Imaging findings on MRI:

(1) vasogenic edema of the brain, predominantly in the posterior cerebral white matter (parietal and occipital lobes) and typically symmetric

(2) lesions may also be seen in gray matter

(3) absence of other explanations (stroke, tumor, infection, etc)


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