PRES

PRES

Posterior reversible encephalopathy syndrome

woman who was at shirley ryan and had two general tonic seizures

Pathophysiology

Unclear, may be related to cerebral autoregulation and endothelial disfunction.

Proposed mechanisms:

Autoregulatory failure and hypertension. Arieriolar dilation and cerebral blood flow increase in a pressure-passive manner at the extremes of high BP. brain hyperperfusion in arterial border zones may lead to breakdown of BBB and extravasation of fluid and blood products into parenchyma.

Usual Presentation

Headaches: constant, nonlocalized, moderate/severe, unresponsibe to analgesia

Altered consciousness: mild sleepiness (somnolence) to confusion and agetation, or even stupor or coma

Visual disturbances: hemianopia, visual neglect, auras, hallucinations, cirtical blindness.

Seizures (often the presenting manifestation). Generalized tonic clonic usually. May egin focally.May recur. Status epilepticus can occur. Minority are seizure free.

Evaluation: imaging. CT is first, and a noncontrast MRI should always be performed. Typical findings: white matter edema in posterior cerebral hemispheres, especially parieto-occipital regions.