Revision 30 for 'Posterior reversible encephalopathy syndrome'

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Posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (Pres syndrome), is a neurotoxic state with caracteristical changes at MRI and CT. Recognized in various conditions like eclampsia, BMT , organs transplant, autoimmune disease, arterial blood hypertension, infection  and sepsis.

The simptoms can be acute and subacute and include headache, visual changes, paresia, hemianopsia, nausea and altered mental status. 

Hypertension is not present or not reach the upper limits to self-regulation ( 150-160 mmHg ) in 25% of patients.

The PRES mechanism remains controversial  but there was two main theories:

  1. High blood pressure leads to loss of self-regulation, hyperperfusion with endothelial damage and vasogenic edema.
  2. Endothelial dysfunction leads to vasoconstriction and hypoperfusion resulting in cerebral ischemia and subsequent vasogenic edema.

There are three mais imaging patterns:

  1. Holohemispheric at watershed zones.
  2. Superior frontal sulcus.
  3. Parieto-occipital dominance.

Interestingly in our case the patient had not increase in blood pressure. In fact she had a myriad of conditions correlated to HIV/ AIDS that probably had resulted in a state toxic/ inflammatory that begat PRES.

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