Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care.
OBJECTIVE
To describe the signs, symptoms, causative factors, and treatment for posterior reversible encephalopathy syndrome (PRES), an emerging clinical neuroradiologic entity which may be encountered by nurse practitioners in almost any clinical setting.


METHODS
Extensive review of worldwide literature, including peer-reviewed medical specialty journals, supplemented by an actual case study. Currently, a paucity of information exists in the nursing literature.


CONCLUSIONS
PRES occurs as a result of disordered cerebral circulatory autoregulation and/or endothelial dysfunction, usually as a result of acute, intermittent hypertension. Clinical manifestations include mental status change, headache, visual disturbance, and seizures. Characteristic abnormalities in the posterior cerebral white matter, seen best on diffusion-weighted magnetic resonance imaging, confirm the presence of the syndrome. PRES has been documented worldwide among a diverse patient population, yet many clinicians are still unfamiliar with this diagnosis.


CONCLUSIONS
PRES is a clinical-radiographic diagnosis that requires close collaboration between the clinician and interpreting radiologist. Rapid identification and appropriate diagnostics are essential, as prompt treatment usually results in reversal of symptoms; permanent neurologic injury or death can occur with treatment delay.
O'Hara McCoy
Heather
H
Scottsdale Healthcare Osborn, Department of Neurosurgery, Scottsdale, Arizona 85251, USA. hmccoy@shc.org
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015984:Causality; D002648:Child; D003422:Critical Care / Q000458:organization & administration*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D009722:Nurse Practitioners / Q000458:organization & administration*; D013577:Syndrome; D014057:Tomography, X-Ray Computed
D000927:Anticonvulsants; D000959:Antihypertensive Agents