PRES (Posterior Reversible Encephalopathy Syndrome): potential complication of hypertensive crisis. Case report and literature review

Michele Vergura, Michele Prencipe, Antonio Maria Del Giudice, Rachele Grifa, Filomena Miscio, Anna Maria Pennelli, Teresa Popolizio, Anna Simeone, Mariangela Ferrara, Maurizio Leone, Filippo Aucella

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome, usually reversible, characterized by vasogenic oedema in cerebral posterior regions in patients with autoimmune diseases, nephropathies, hypertensive crisis, eclampsia and exposure to cytotoxic drugs. The main symptoms are: headache, nausea, vomiting, seizures, visual disturbance and altered consciousness. Complications as cerebral hemorrhage and recurrences are rare. We describe a case of a 65 years old woman, affected by chronic kidney disease, recently exacerbated, diabetes and hypertension in treatment, who showed an heterogeneous clinical presentation with vomiting, headache, blurred vision and impaired consciousness during an episode of acute hypertension. After an adjustement of the antihypertensive treatment we observed a regression of symptoms in one week. FLAIR sequences on MRI showed cerebral bilateral vasogenic oedema in posterior regions, typical for PRES. This case was suggestive for PRES and a prompt adjustement of the antihypertensive treatment was critical for clinical recovery. Brain MRI was crucial for diagnosis. It is important for clinicians to recognize PRES as a possible complication of renal disease and hypertensive crisis.

Original languageEnglish
Pages (from-to)100-109
Number of pages10
JournalGiornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia
Volume34
Issue number2
Publication statusPublished - Apr 1 2017

Fingerprint

Posterior Leukoencephalopathy Syndrome
Brain Edema
Consciousness
Antihypertensive Agents
Vomiting
Headache
Hypertension
Eclampsia
Cerebral Hemorrhage
Chronic Renal Insufficiency
Nausea
Autoimmune Diseases
Seizures
Therapeutics
Kidney
Recurrence
Brain
Pharmaceutical Preparations

Keywords

  • Chronic kidney disease
  • Hypertension
  • Magnetic Resonance Imaging
  • Posterior reversible encephalopathy syndrome

ASJC Scopus subject areas

  • Medicine(all)

Cite this

PRES (Posterior Reversible Encephalopathy Syndrome) : potential complication of hypertensive crisis. Case report and literature review. / Vergura, Michele; Prencipe, Michele; Del Giudice, Antonio Maria; Grifa, Rachele; Miscio, Filomena; Pennelli, Anna Maria; Popolizio, Teresa; Simeone, Anna; Ferrara, Mariangela; Leone, Maurizio; Aucella, Filippo.

In: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, Vol. 34, No. 2, 01.04.2017, p. 100-109.

Research output: Contribution to journalArticle

Vergura, Michele ; Prencipe, Michele ; Del Giudice, Antonio Maria ; Grifa, Rachele ; Miscio, Filomena ; Pennelli, Anna Maria ; Popolizio, Teresa ; Simeone, Anna ; Ferrara, Mariangela ; Leone, Maurizio ; Aucella, Filippo. / PRES (Posterior Reversible Encephalopathy Syndrome) : potential complication of hypertensive crisis. Case report and literature review. In: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia. 2017 ; Vol. 34, No. 2. pp. 100-109.
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