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Posterior reversible encephalopathy syndrome in intensive care medicine

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Abstract

Background

Posterior reversible encephalopathy syndrome (PRES) is a well-recognized clinico-neuroradiological transient condition. Early recognition is of paramount importance for prompt control of blood pressure or removal of precipitating factors and treatment of epileptic seizures or status epilepticus. Delay in the diagnosis and treatment may in fact results in death or in irreversible neurological sequelae.

Discussion

PRES is characterized by headache, altered mental status, seizures, and visual disturbances and is associated with a number of different causes, most commonly acute hypertension, preeclampsia/eclampsia, and immunosuppressive agents. Clinical symptoms and neuroradiological findings are typically indistinguishable among the cases of PRES, regardless of underlying cause. Magnetic resonance studies typically show edema involving the white matter of cerebral posterior regions, especially parieto-occipital lobes but frontal and temporal lobes, and other encephalic structures may be involved.

Conclusions

Intensivists and other physicians involved in the evaluation of patients with presumed PRES must be aware of the clinical spectrum of the associated conditions, the diagnostic modalities, and the correct treatment.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Department of Surgical and Anesthesiological Sciences, Naples, Italy

    Giuseppe Servillo, Francesca Bifulco, Edoardo De Robertis, Ornella Piazza & Rosalba Tufano

  2. Epilepsy Centre, Department of Neurological Sciences, Federico II University, Naples, Italy

    Pasquale Striano & Salvatore Striano

  3. Service of Neuroradiology, Federico II University, Naples, Italy

    Fabio Tortora

Authors
  1. Giuseppe Servillo
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  2. Francesca Bifulco
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  3. Edoardo De Robertis
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  4. Ornella Piazza
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  7. Salvatore Striano
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  8. Rosalba Tufano
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Correspondence to Giuseppe Servillo.

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Servillo, G., Bifulco, F., De Robertis, E. et al. Posterior reversible encephalopathy syndrome in intensive care medicine. Intensive Care Med 33, 230–236 (2007). https://doi.org/10.1007/s00134-006-0459-0

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