Posterior reversible encephalopathy syndrome

J Intensive Care Med. 2012 Feb;27(1):11-24. doi: 10.1177/0885066610393634. Epub 2011 Jan 21.


Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual disturbances, and seizures. Radiological features typically include edema of the posterior cerebral regions, especially of the parietooccipital lobes. Atypical imaging features, such as involvement of anterior cerebral regions, deep white matter, and the brain stem are also frequently seen. Vasoconstriction is common in vascular imaging. Different conditions have been associated with PRES, but toxemia of pregnancy, solid organ or bone marrow transplantation, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension are most commonly described. The pathophysiology of PRES is unclear and different hypotheses are being discussed. Posterior reversible encephalopathy syndrome is best managed by monitoring and treatment in the setting of a neurointensive care unit. The prognosis is usually benign with complete reversal of clinical symptoms within several days, when adequate treatment is immediately initiated. Treatment of severe hypertension, seizures, and withdrawal of causative agents represent the hallmarks of specific therapy in PRES. Delay in diagnosis and treatment may lead to permanent neurological sequelae. Therefore, awareness of PRES is of crucial importance for the intensivist.

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / diagnosis
  • Autoimmune Diseases / drug therapy
  • Bone Marrow Transplantation / pathology
  • Cerebrovascular Circulation / physiology
  • Comorbidity
  • Critical Care / methods*
  • Diagnosis, Differential
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / therapy
  • Hypertensive Encephalopathy* / diagnosis
  • Hypertensive Encephalopathy* / drug therapy
  • Hypertensive Encephalopathy* / physiopathology
  • Immunosuppressive Agents / therapeutic use
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging / methods
  • Nervous System Diseases / diagnosis
  • Nervous System Diseases / therapy
  • Organ Transplantation / pathology
  • Posterior Leukoencephalopathy Syndrome / diagnosis
  • Pre-Eclampsia / diagnosis
  • Pre-Eclampsia / drug therapy
  • Pre-Eclampsia / prevention & control
  • Pregnancy


  • Antineoplastic Agents
  • Immunosuppressive Agents