Journal of Clinical Ophthalmology and Research

: 2015  |  Volume : 3  |  Issue : 1  |  Page : 37-

Posterior reversible encephalopathy: Not an under-recognized entity

Khichar Purnaram Shubhakaran1, Rekha Jakhar Khichar2,  
1 Department of Neurology, Dr. S. N. Medical College, Jodhpur - 342 001, Rajasthan, India
2 Department of Obstetrics and Gynaecology, Dr. S. N. Medical College, Jodhpur - 342 001, Rajasthan, India

Correspondence Address:
Khichar Purnaram Shubhakaran
House No: 22/9, Umaid Hospital Campus, Jodhpur - 342 001, Rajasthan

How to cite this article:
Shubhakaran KP, Khichar RJ. Posterior reversible encephalopathy: Not an under-recognized entity.J Clin Ophthalmol Res 2015;3:37-37

How to cite this URL:
Shubhakaran KP, Khichar RJ. Posterior reversible encephalopathy: Not an under-recognized entity. J Clin Ophthalmol Res [serial online] 2015 [cited 2020 Nov 29 ];3:37-37
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We read an interesting case report by Nayak published in April 2014 issue of this esteemed journal. [1] Of course, the posterior reversible encephalopathy syndrome (PRES) was recognized in 1996, [2] but with the advent of modern imaging specially magnetic resonance imaging (MRI) the disease is not under-recognized more so in pregnant females in peripartum period. In a peripartum lady with the signs and symptoms of headache, nausea, vomiting, seizures, visual disturbances, altered sensorium, with or without focal neurological deficits, with rapidly progressive blood pressure, an expert clinicians will certainly think of PRES or will be guided by referral neurologist and goes for MRI straight forward. Rarely, there could be spinal cord involvement also in PRES.

Among the important causes of PRES besides eclampsia, the other ones are renal disease, hypertensive encephalopathy, systemic lupus erythematosus, sepsis, thrombotic thrombocytopenic purpura, endocrinopathies, cytotoxic/immunosuppressive drug therapy, e.g., cyclosporin, tacromilus, complication of reversible cerebral vasoconstriction syndrome.

It has also been argued that this syndrome may be a neuroradiological expression of various metabolic disorders, which affect the central nervous system including seizures. We in our day today practice frequently encounter such patients and if deserve than also get them documented. [3],[4] There is also a recent case report of PRES with rodenticide poisoning. [5]

The first-line drug of choice for such patients is the beta blocker labetalol and calcium channel blocker given intravenously in a critical care setting with close hemodynamic monitoring. Sodium nitroprusside is not considered because of its adverse effect on cerebral blood flow. The aim of this correspondence is to make awareness that PRES is not an under recognized entity for the sense that misdiagnosis of an under-recognized disease is excusable up to some extent, which is not so in well recognized disease entity.


1Kamath SJ, Multani P, Nayak MA. Posterior reversible encephalopathy syndrome. J Clin Ophthalmol Res 2014;2:111-2.
2Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500.
3Bhargava A, Banakar BF, Pujar GS, Shubhakaran K, Jangid H. An unusual case of reversible cerebral vasoconstriction syndrome presenting during antepartum period. Neurol India 2014;62:91-2.
4Banakar BF, Pujar GS, Bhargava A, Shubhakaran K. Guillain-Barre syndrome with posterior reversible encephalopathy syndrome. J Neurosci Rural Pract 2014;5:63-5.
5Kim JB, Jang JW, Kim JH. Reversible leukoencephalopathy in sodium monofluoroacetate intoxication. Neurology 2014;82:1190-1.