Exploring the Spectrum: An Original Observational Study of Posterior Reversible Encephalopathy Syndrome from Tertiary Center in Kerala

Abstract

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a disorder of subcortical vasogenic edema causing reversible neurologic dysfunction which includes headache, altered sensorium, seizures, and visual disturbances. It is a relatively rare disease with a myriad of nonspecific symptoms with similar presentations to that seen in other diseases such as stroke and cortical venous thrombosis. Hence, accurate diagnosis is needed for early detection to guide the management of such patients. This is a single-center retrospective study from June 2022 to May 2024 to identify the demographic profile, etiologies, imaging features, and prognosis of patients diagnosed with PRES. Materials and Methods: Diagnosis of PRES was made on the basis of clinical history, neurological examination, and magnetic resonance imaging brain after ruling out other possible differential diagnoses. The patients who satisfied Fugate et al. criteria were included in the study. The data were collected from the hospital database. Patients with alternate diagnoses were excluded from the study. Results: There were 22 patients diagnosed with PRES. There were 20 (91%) females among the cohort. Eighteen (82%) patients had headache. Fourteen (64%) patients had seizures all of which were generalized tonic–clonic seizures. All had positive imaging findings with 2 patients having leptomeningeal enhancement in the presence of normal cerebrospinal fluid findings. Blood pressure (BP) was normal in 5 (22%) patients. Most of the patients were postpartum without a prior history of hypertension or preeclampsia. Conclusion: PRES is a reversible entity with the imaging findings primarily involving the posterior part of the brain. It can also involve anterior circulation and spinal cord. Normotensive PRES is possible and should not be overlooked if the patient has all features of PRES but has normal BP. It has a female predilection with the most vulnerable state being immediate postpartum. Although recurrence is possible, PRES does not require long-term medications. Complicated PRES presents with SAH and intracranial hemorrhage.