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Posterior Reversible Encephalopathy Syndrome - #PHARMFAX

Posterior reversible encephalopathy syndrome (PRES) isn’t always actually reversible.


Posterior reversible encephalopathy syndrome (PRES) isn’t always actually reversible. PRES is thought to be caused by abnormalities in cerebral autoregulation. Severe hypertension can cause increases in hydrostatic pressure in the brain, causing endothelial damage and leakage in brain tissue, leading to edema. Patients can present with stroke-like symptoms and seizures in the setting of severe hypertension.

Risk factors include untreated hypertension, cytoxic drugs like tacrolimus, pre-eclampsia, and autoimmune disorders. CT imaging will be a part of your stroke workup, but PRES is confirmed on MRI. Let’s get going on saving brain cells.

If presenting with seizures, BZDs are our anticonvulsant of choice. Get something cookin’ for the underlying cause, which is the hypertension. Your best options are intermittent pushes of IV labetolol and clevidipine or nicardipine drips. These are excellent for neuro-hypertensive crisis given how lipiphilkic and readily they cross the BBB.

Don’t drop the blood pressure by more than 20% in the first 1-2 hours as this may lead to cerebral hypoperfusion. Did you check the PHARMFAX? Check out another video on my page.

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