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Emergency: requires immediate attention
Reversible posterior leukoencephalopathy syndrome
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Emergency: requires immediate attention

Reversible posterior leukoencephalopathy syndrome

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Contributors: Andrea Wasilewski MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

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Synopsis

Reversible posterior leukoencephalopathy syndrome : Agitation, Altered mental state, Seizures, Headache, Delirium, Patient appears ill, Drowsiness
Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is a clinical syndrome consisting of rapid onset headaches, altered levels of consciousness, visual disturbances, and seizures associated with characteristic radiologic findings on MRI including symmetric white matter edema in the posterior cerebral hemispheres, especially the parieto-occipital regions. Occasionally, gray matter is involved. Headaches are typically moderate to severe, nonlocalized, and unresponsive to analgesia. Seizures may be the presenting manifestation and are usually generalized tonic-clonic. Altered consciousness ranges from confusion and mild somnolence to coma.

Physical examination often reveals hypertension and detectable visual perception abnormalities, including hemianopia, cortical blindness, or visual neglect. Reflexes are brisk and Babinski sign is often present. Risk factors for development of RPLS include hypertension, eclampsia, and immunosuppressive therapy, especially cyclosporine, tacrolimus, sirolimus, cisplatin, and rituximab.

Treatment is aimed at the precipitating cause, and prompt treatment is necessary given the potentially reversible nature of the condition. Onset is usually over hours to a day. Most patients recover within 2 weeks, with few patients having residual neurologic deficits.

Codes

ICD10CM:
I67.83 – Posterior reversible encephalopathy syndrome

SNOMEDCT:
450886002 – Posterior reversible encephalopathy syndrome

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:04/09/2018
Last Updated:07/09/2018
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Emergency: requires immediate attention
Reversible posterior leukoencephalopathy syndrome
Print  
A medical illustration showing key findings of Reversible posterior leukoencephalopathy syndrome : Agitation, Altered mental state, Seizures, Headache, Delirium, Patient appears ill, Drowsiness
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