title: Clinical spectrum and critical care management of Posterior Reversible Encephalopathy Syndrome (PRES).
abstract: BACKGROUND
  Posterior Reversible Encephalopathy (PRES) is characterized by acute-onset headache, altered mental status, cortical blindness and seizures, with parietal-occipital involvement. We report all cases of PRES diagnosed in our intensive care unit during the last 4 years, and evaluate their outcome in terms of the different medical treatments used. Even if usually reversible, PRES can sometimes result in death or irreversible neurological deficit, such as chronic epilepsy.
  
  
  METHODS
  From January 2001 to January 2005, we identified 8 female patients with PRES. All patients underwent basal and follow-up brain MRI. Patients referred to Epilepsy Center (about 3000 patients) were reviewed in order to identify subjects with a clinical history of PRES. These latter were clinically re-evaluated and underwent video-EEG, MRI study and neuropsychological testing.
  
  
  RESULTS
  Of the 8 patients, 5 had hypertensive encephalopathy during pregnancy; 2 had eclampsia during the postpartum period; 1 patient with chronic renal failure developed symptoms after immunosuppressive treatment. In all patients but 1, neurological and radiological abnormalities resolved after appropriate treatment. In addition, we found 2 patients with temporal lobe epilepsy subsequent to a previous PRES. MRI revealed cortical-subcortical malacia in the parietal-occipital regions.
  
  
  CONCLUSIONS
  The widespread use of MRI technology has made PRES familiar to many clinicians. Although PRES is reversible when treatment is instituted, delayed diagnosis and therapy can result in chronic neurological sequelae. The relationship between hypertensive encephalopathy and chronic epilepsy needs to be confirmed by longitudinal studies. Normalization of blood pressure and treatment of seizures deserves particular attention.
authors.affiliation: Epilepsy Center, Department of Neurological Sciences, Federico II University, Naples, Italy. sstriano@libero.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Striano
authors.forename: Salvatore
authors.initials: S
authors.lastname: Striano
authors.forename: Fabio
authors.initials: F
authors.lastname: Tortora
authors.forename: Edoardo
authors.initials: E
authors.lastname: De Robertis
authors.forename: Daniela
authors.initials: D
authors.lastname: Palumbo
authors.forename: Andrea
authors.initials: A
authors.lastname: Elefante
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Servillo
mesh_terms: D019575:Blindness, Cortical / Q000175:diagnosis; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000628:therapy*; D003422:Critical Care; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D012640:Seizures / Q000175:diagnosis / Q000628:therapy; D013577:Syndrome