UpToDate: Posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms-seizures, headaches, altered mental status, and visual changes-associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences.


The etiology of this entity includes a sudden increase in blood pressure, renal failure, immunosuppressive drugs, infections, and intravenous immunoglobulin (IVIG).

The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice.


Classically, magnetic resonance imaging (MRI) findings show a symmetric reversible vasogenic edema in the parietooccipital lobes. PRES can involve the brainstem and cerebellum and sometimes can leave irreversible lesions but it can also recur, which is a very rare presentation.

Case reports

Hage et al., report a case of recurrent PRES with cerebellar involvement associated with noncommunicating hydrocephalus in a 2-year-old child with renal failure on peritoneal dialysis after receiving Etoposide for macrophage activation syndrome 1).


Quarante et al report 2 new pediatric cases of posterior reversible encephalopathy syndrome (PRES) that developed after surgical resection of a posterior fossa tumor. Appropriate management includes supportive measures, antihypertensive agents, and antiepileptic drugs, if needed. Full recovery is the most likely outcome in line with previous articles 2).


Sorour et al. report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. Conclusion PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome 3).


Hage P, Kseib C, Hmaimess G, Jaoude PA, Noun P. Recurrent posterior reversible encephalopathy syndrome with cerebellar involvementleading to acute hydrocephalus. Clin Neurol Neurosurg. 2018 Jul 5;172:120-123. doi: 10.1016/j.clineuro.2018.07.005. [Epub ahead of print] PubMed PMID: 29990959.

Quarante LH, Mena-Bernal JH, Martín BP, Carrasco MR, Casado MJ, de Aragón AM, de Las Heras RS. Posterior reversible encephalopathysyndrome (PRES): a rare condition after resection of posterior fossa tumors: two new cases and review of the literature. Childs Nerv Syst. 2016 May;32(5):857-63. doi: 10.1007/s00381-015-2954-5. Epub 2015 Nov 19. Erratum in: Childs Nerv Syst. 2016 Apr;32(4):763. PubMed PMID: 26584552.

Sorour M, Sayama C, Couldwell WT. Posterior Reversible Encephalopathy Syndrome after Surgical Resection of a Giant Vestibular Schwannoma: Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg. 2015 Jun 19. [Epub ahead of print] PubMed PMID: 26091111.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

WhatsApp WhatsApp us
%d bloggers like this: