European Journal of Cardiovascular Medicine

Posterior Reversible Encephalopathy Syndrome (PRES) also referred to as Reversible posterior cerebral edema syndrome, hyper perfusion encephalopathy, Posterior leukoencephalopathy syndrome, Brain capillary leak syndrome is a clinical-radiographic syndrome was first described by Hinchey  in 1996 ¹.Subacute in onset, it has varied neurological features ranging from headache, loss of consciousness, seizures, visual disturbances and focal neurological deficits. It is often found to be associated with a number of conditions like malignant hypertension, pregnancy induced hypertension, antineoplastic treatments, cytotoxic and immunosuppressive drugs and certain autoimmune conditions.² Because of its varied presentation as well as its association with a number of conditions, this rather newer entity in the spectrum of hypertensive encephalopathy patients is becoming more commoner than usual due to increased awareness not only among neurologists but  also among other clinicians who are crucial in having a high index of suspicion to identify this syndrome. Management of patients with hypertensive emergencies and hypertensive encephalopathy which can range from mild neurological deficits to coma and seizures is often in done the multidisciplinary ICUs and knowledge about this condition and risk factors is essential to intensivists who are the primary care givers in these areas.

Though reversibilityis a hallmark feature,long term sequalae can be present if diagnosis and treatment is delayed which further stresses the importance of its early recognition.

Here we have 5 cases admitted with varied presentations and etiologies to our multidisciplinary ICU over a period of 1 year.

A retrospective analysis of 5 patients who were admitted to an adult MICU and diagnosed with PRES over a 1‑year period from 2021 to 2022 was done.

Demographic data like Age and Gender, past medical history, symptoms at presentation and other neurological symptoms including like Seizures, Headache, Visual disturbances, GCS with any Focal neurological deficit if any was noted. The peak blood pressure during the course, any requirement of ventilator, the radiological findings in CT and MRI was also noted. The patient’s status at discharge, MRI after recovery if any, outcome at 90 days were also followed up.

Index:- GTCS –generalized tonic clonic seizures POG-period of gestation, MPGN-membranoproliferative glomerulonephritis, LSCS-lower segment caesarean section , CKD –chronic kidney disease, MHD-maintenance haemodialysis ,TTP- thrombotic thrombocytopenic purpura, LRTI- lower respiratory tract infection, CXR-chest X ray ,MMF-mycophenolate mofetil

Image 1-T2 FLAIR showing an ill -defined high signal in the right occipital lobe-atypical presentation of PRES (Case 5)

Image 2 DWI image showing a subtle restricted diffusion in the right occipital lobe-maybe due to edema(case 5)

Image 3 –T2 FLAIR image showing ill -defined high signal changes in the right frontal lobe (case1)

Image 4 –DWI showing subtle restricted diffusion in the right frontal lobe(case1 )

Image 5 and 6 –T2 FLAIR images showing bilateral symmetrical hyperintensitites involving the frontal lobes, centrum semiovale and bilateral occipital lobes (case 3)