Posterior Reversible Encephalopathy Syndrome (PRES) is a relatively newly-recognized condition characterized by headache, convulsions, confusion, and vision loss (i.e."CCCV," "Cephalgia,Convulsions, Confusion, Vision loss.")
Risk factors include: severe hypertension, eclampsia, renal failure, and use of immunosuppressive medications such as tacrolimus and cyclosporine; low magnesium levels may exacerbate PRES.
PRES may be under-recognized because its diagnosis is based on both clinical and radiographic findings. Brain MRI findings classically show bilateral hyperintense densities in the parieto-occipital regions on T2 weighted images (see attached image).
Treatment of PRES consists of managing the underlying cause such as lowering blood pressure and discontinuing offending medications, which typically results in resolution of symptoms.
Take Home Point: Consider PRES as the etiology of unexplained constellations of symptoms including headache, seizure, confusion, and vision loss in the setting of severe hypertension, particularly amongst patients with renal failure and on immunosuppressants.
References
Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494-500.
Lee H. Posterior Reversible Encephalopathy Syndrome. Applied Radiology. 2007;36(5):42-43.
Moratalla MB. Posterior Reversible Encephalopathy Syndrome. Emerg Med J. 2010 Jul;27(7):547.
