PRES PRES stands for 'Posterior Reversible Encephalopathy Syndrome,' although MRI findings are not always posterior, and the symptoms are not always reversible. It is often triggered by sudden rise in BP. Timing and symptoms can help you determine your level of suspicion for PRES. If high, MRI is more sensitive than CT. Establish a Timeline How long has it been since the onset? Minutes
Hours
Days
Weeks
Months
Years
How long have the symptoms been present? Minutes
Hours
Days
Weeks
Months
Years
Symptoms suggestive of PRES AMS (mild disorientation to coma)
Headache (typically constant, non-localized, moderate-severe, unresponsive to analgesia)
Vision changes (blurry vision, hemianopia, visual neglect, auras, hallucinations, cortical blindness)
Seizures (focal with secondary generalization; may have epileptic visual aura preceding seizure)
Other neurologic symptoms present
Recent medication changes
Prior history of PRES, hypertensive emergency, seizure, stroke
Risk factors for PRES Hypertension
Sepsis
Recent blood transfusion
Eclampsia/post-partum
Bone marrow or stem cell transplant
Acute or chronic kidney disease
Hemolytic uremic syndrome
Thrombotic Thrombocytopenic Purpura
Reversible Cerebral Vasoconstrictive Syndrome
Autoimmune disease
SLE
Hypothyroidism
Scleroderma
Crohns/UC
Primary sclerosing cholangitis
Rheumatoid Arthritis
T1DM
Anti-phospholipid syndrome
Autoimmune hepatitis
Polyarteritis nodosa
Sjogrens
NMO
Illicit drug or alcohol intoxication/overdose
Medications IVIG
Interferon
Cyclophosphamide
Tacrolimus
Cyclosporine
Mycophenolate
Bevacizumab
Rituximab
Vincristine
Methotrexate
Hydroxychloroquine
5-fluorouracil
Sirolimus
Thalidomide
Gemcitabine
Paclitaxel
Carboplatin
Sorafenib
Infliximab
Hydroxyurea
Prior Workup Prior brain imaging
Prior EEG
Prior lumbar puncture