title: Immunosuppressive Drugs, an Emerging Cause of Posterior Reversible Encephalopathy Syndrome: Case Series.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is a well-recognized complication of hypertensive encephalopathy. Recently, pre-eclampsia, connective tissue disorders, and immunosuppressive drugs have been reported to be the etiologies of this rare syndrome.
  
  
  METHODS
  We evaluated 9 cases of PRES whose diagnosis were confirmed based on clinical and radiologic evidence between July 2011 and December 2013 in a tertiary center, Imam Khomeini Hospital, Tehran, Iran.
  
  
  RESULTS
  Immunosuppressive drugs, especially cyclosporine, and hypertension were the main precipitating factors. In this study, seizure was the most common clinical presentation (100%), whereas other common clinical presentations were confusion (78%), visual loss (67%), and headaches (67%). With conservative management and elimination of predisposing factor, the patients improved gradually except for 2 cases who experienced prolonged recovery period because of delayed diagnosis.
  
  
  CONCLUSIONS
  With timely diagnosis, PRES generally has a good prognosis with complete recovery. However, in missed conditions, it could be associated with catastrophic burden especially in organ transplantation after a prolonged time spending to find matched donors or in chronic immunosuppressive conditions. Thereupon, physicians should be aware of clinical and radiologic manifestations of this preventable but potentially disabling syndrome.
authors.affiliation: Iranian Center of Neurological Research, Neurology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Harirchian
authors.affiliation: Iranian Center of Neurological Research, Neurology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Ghaffarpour
authors.affiliation: Iranian Center of Neurological Research, Neurology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tabaeizadeh
authors.affiliation: Iranian Center of Neurological Research, Neurology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: b-siroos@razi.tums.ac.ir.
authors.forename: Bahaadin
authors.initials: B
authors.lastname: Siroos
mesh_terms: D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000150:complications
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: Posterior reversible encephalopathy syndrome; hypertension; immunosuppressive drugs; organ transplantation