Posterior Reversible Encephalopathy Syndrome

Acute cerebral syndrome secondary to severe hypertension, characterised by:

Epidemiology and Risk Factors

Risk factors:

  • ESRD
  • SLE
  • Organ transplantation
  • Pre-eclampsia or eclampsia

Pathophysiology

Aetiology

Three categories of precipitants are described:

  • Primary hypertensive disorder
  • Immunosuppressants
  • Chemotherapeutics

Clinical Features

  • Headache
  • Encephalopathy
    98%. Confusion → coma.
  • Seizures
    ~20% develop status epilepticus.
  • Visual disturbances 20-40%. Include:
    • ↓ Acuity
    • Neglect
    • Hallucinations
    • Blindness
  • Focal paresis

Assessment

History:

Exam:

Investigations

Bedside:

Laboratory:

Imaging:

  • MRI
    Vasogenic oedema in occipital and adjacent parietal lobe.

Other:

Diagnostic Approach and DDx

  • Posterior circulation stroke
  • CNS infection
  • Demyelinating disease
  • Malignancy
  • Cerebral venous sinus thrombosis

Management

  • Treat precipitant
  • Control hypertension
  • Control seizures

Resuscitation:

Specific therapy:

  • Pharmacological
  • Procedural
  • Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

Prognosis

Key Studies

References

  1. Geocadin RG. Posterior Reversible Encephalopathy Syndrome. New England Journal of Medicine. 2023;388(23):2171-2178. doi:10.1056/NEJMra2114482