Practical Neurology Podcast Posterior reversible encephalopathy syndrome (PRES): diagnosis and management
Jun 21, 2022
In this insightful discussion, Dr. Todd Hardy, a clinical associate professor and expert on clinical neurology, teams up with Dr. James Triplett, a neurophysiologist and senior lecturer, to decode Posterior Reversible Encephalopathy Syndrome (PRES). They delve into the complexities of diagnosing PRES, the challenges of clinical criteria, and the significance of MRI findings. The duo also explores various risk factors, management strategies, and the importance of thorough patient history, all while navigating the murky waters between disease and medication causes.
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PRES Is A Heterogeneous Clinicoradiological Syndrome
- PRES is a clinico-radiological syndrome with seizures, headache, visual loss and encephalopathy that supports diagnosis with MRI findings.
- Common triggers include hypertension, eclampsia, immunosuppression and chemotherapy, and presentations vary widely.
Ask For Triggers And Medications
- Take a thorough history focused on hypertension, sepsis, renal failure, eclampsia, malignancy and autoimmune disease when PRES is suspected.
- Always review medications carefully for cytotoxic or immunosuppressive drugs that can precipitate PRES.
MRI Patterns Vary But Often Affect Occiput
- MRI typically shows bilateral cortical and subcortical T2 FLAIR hyperintensities, often occipital-predominant, with vasogenic oedema on DWI/ADC.
- Atypical patterns include frontal, central, brainstem or cerebellar involvement; imaging mirrors clinical features.