PRES (Posterior Reversible Encephalopathy Syndrome)

An overview of the posterior reversible encephalopathy syndrome, better known as PRES.

This video is part of Strong Medicine's Underappreciated Diseases series. It is meant for educational purposes only, and is not intended to direct the diagnosis or management of any specific patient. I do not claim any notable expertise in this specific disease, and unfortunately, I am unable to provide individualized medical advice in response to comments posted here.

For more information on PRES:

#neurology #PRES

[StrongMed]

A few additional notes:

In the video, I state that hypertension in PRES should be treated by aiming for a 10-25% reduction in BP within the first 2-6 hrs. While this represents the generally acceptable range, most clinicians aim for the upper end (i.e. a 20-25% reduction). For example, if the BP was 240/120 in a person with likely PRES (i.e. risk factor + symptoms, while awaiting MRI), in my experience most clinicians would prefer a reduction closer to 180/90 (25%) rather than just a reduction to 216/108 (10%) - but preventing repeated, rapid fluctuations is essential!

Also, the management of PRES in the setting of eclampsia is a bit different than in other situations (e.g. using magnesium to prevent seizures, prompt delivery of the baby ASAP, etc...)

[padamjadon]

Dr Strong you are an epitome of a scholar and a doctor.

[missescook]

I was just diagnosed with PRES. I spent eight days in the hospital 1 being my 40th bday. Did anyone experience delusions or seeing and hearing things that were not there? I did it was absolutely horrible.

[krapsi]

Awesome video! The Preeclampsia/Eclampsia risk factor is rather intriguing since there act almost all of the predisposing factors simultaneously namely the endothelial dysfunction and the hypertension. However the vasogenic edema there might be observed even in not so high of a blood pressure.

[dailydoseofmedicinee]

Corticosteroids should theoretically improve vasogenic edema, but there is no evidence for their use in PRES👍

[maxlichtenberger]

Your videos are so helpful!
Can you do a Video about an approach to eosinophilia.

[aadammohamed]

thanks very much you presentation, i request to discuss the best books of residency cardiology ( book for specialist for cardiology)

[salvadorfeliperodbec]

Most brobabbly related to high metabolic activity of occipital cortex in a wake state, even at rest.

[Maryam-wdhs]

Very impressive! Might’ve mistaken you for a neurologist ;)

[ayseakpnar]

I had a patient who has been on tacrolimus for 3 years. Patient started to have intermittant vision changes, tremor, ataxia and AMS which led to severe coma. PRES was considered but serial brain MRs were normal. Is it possible MR to be normal with PRES