Posterior reversible encephalopathy syndrome– our experience

Abstract

Introduction: Posterior Reversible Encephalopathy syndrome (PRES) is an emergency medical condition with varied etiology, presentation and outcome reported in literature. The objective of this study was to determine the clinical and radiological presentations, and clinical outcomes in cases of PRES admitted over the last one year at a tertiary care hospital.Materials and Methods: We retrospectively analysed all cases diagnosed with PRES from May 2019 to May 2020. We reviewed clinical presentations, etiological history, imaging characteristics, management and clinical outcomes.Results: Five patients diagnosed with PRES were identified. All patients were females, with age range between 16 to 32 years. Etiological factors were eclampsia (2/5), drug (tacrolimus), massive blood transfusion and chronic kidney disease with hypertension. Headache was the most common clinical presentation. Other clinical presentations were visual symptoms, seizures, altered sensorium, vertigo and vomiting. The most common imaging characteristic was supratentorial T2/FLAIR white matter hyperintensity on MRI, predominantly in parieto-occipital region. Other areas of white matter involvement were cerebellum and brainstem. One patient had hemorrhage complicating PRES. All patients were primarily managed by elimination and treatment of the precipitating factors, along with standard anti-oedema measures and anti-epileptic drugs. There was complete recovery in all patients within one week.Conclusion: PRES has variable clinical and radiological presentation. Early diagnosis and elimination of precipitating factors are vital for complete recovery.