Posterior Reversible Encephalopathy Syndrome: A Truly Treatable Neurologic Illness

Posterior reversible encephalopathy syndrome PRES (also known as reversible posterior leukoencephalopathy syndrome) presents with rapid onset of symptoms including headache, seizures, altered consciousness, and visual disturbance (1,2). It is often—but by no means always—associated with acute hypertension (1,2). If promptly recognized and treated, the clinical syndrome usually resolves within a week (2,3), and the changes seen in magnetic resonance imaging (MRI) resolve over days to weeks (2–4). Chronic kidney disease and acute kidney injury are both commonly present in patients with PRES (4), and PRES is strongly associated with conditions that co-exist in patients with renal disease, such as hypertension, vascular and autoimmune diseases, exposure to immunosuppressive drugs, and organ transplantation. It is therefore important to consider PRES in the differential diagnosis of patients with renal disease and rapidly progressive neurologic symptoms. Posterior reversible encephalopathy syndrome is an increasingly recognized disorder, with a wide clinical spectrum of both symptoms and triggers, and yet it remains poorly understood.