Posterior reversible encephalopathy syndrome in intensive care medicine

Intensive Care Med. 2007 Feb;33(2):230-6. doi: 10.1007/s00134-006-0459-0. Epub 2006 Nov 21.


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.

Publication types

  • Review

MeSH terms

  • Blood Pressure
  • Critical Care*
  • Diagnosis, Differential
  • Humans
  • Hypertensive Encephalopathy* / diagnosis
  • Hypertensive Encephalopathy* / drug therapy
  • Hypertensive Encephalopathy* / physiopathology
  • Magnetic Resonance Imaging
  • Status Epilepticus / drug therapy