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:
www.ncbi.nlm.nih.gov/pmc/arti...
#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...)

[@pmendapara]

Hi Dr. Strong, Your videos are absolutely amazing! I will be starting intern year very soon and your playlists have been super helpful. Thank you for being such a wonderful teacher!

[@padamjadon3700]

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

[@sunving]

Thank you , Doctor Eric Strong.

[@krapsi1101]

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.

[@clivebanda9238]

Straight to the point. Well explained I like the background music at the end by the way

[@tuskartp6164]

you,sir, just made my day

[@ScottieBMan]

Nice presentation

[@fastmohawk2639]

As Concise and informative as ever!:)

[@johnnyzhang5333]

So concise! Looking forward to more neurology content :)

[@StrongMed]

You're in luck! The next 3 diseases in the series have cross-over with neurology (e.g. POTS, complex regional pain syndrome, cyclic vomiting syndrome). Also planning on adding more neuro topics to the Approach to Symptoms series this winter.

[@johnnyzhang5333]

@@StrongMed perfectly coincided with my neurology clerkship! Thanks for keeping these resources freely available for everyone! 😎

[@salvadorfeliperodbec]

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

[@maxlichtenberger7447]

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

[@StrongMed]

Thanks for the suggestion. I probably won't have a video on that topic in the next few months (too many other competing requests!), but I will be including a video on DRESS as part of this Underappreciated Diseases series.

[@sleepytraveler369]

Good stuff, when are we going to get that insulin therapy video, Doctor?

[@StrongMed]

It's on the list for winter/spring, but I don't want to make a prediction more specific than that because I'll probably break it. (I'm only now finishing up a video on abdominal X-rays that I initially said would be coming ~2017!)

[@marufaleena4535]

Thank u sir ❤️

[@ahmedalbasri7280]

Thanks so much ...from iraq karbala

[@kennyjones6369]

My Mom just passed from this and everything you said the dr`s did. I sit here numb and stunned that i lost my Mom.

[@StrongMed]

I"m so sorry about your loss.

[@kennyjones6369]

@@StrongMed Thank You

[@missescook4955]

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.

[@mahadadowhassan8755]

very intresting presentation u sugested thanks 4 ur well done but let me requist best wepsites related HEART DESEASE & RESPIRATORY THNKS SRONG medicine ❤❤

[@Maryam-wd7hs]

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

[@magedabuldahab7481]

Please, as you began a series of underappreciated diseases, I need your wisdom talk on a video about GCA/PMR with likelihood ratios of their S&S, and QoL if corticosteroids is whether given or not, thanks,

[@StrongMed]

With an interest that specific, you'd be better off looking in the primary literature for a relevant article from a content expert.

[@aadammohamed2252]

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

[@StrongMed]

At the resident level, you are probably better off finding relevant review articles in the primary literature rather than purchasing a cardiology textbook. Between my wife (a cardiologist) and myself, we've got ~20 cardiology books on our bookshelf at home, and most haven't been cracked open in years. However, I concur with Colm that Echo Made Easy is very good. Unfortunately, I think the most recent edition of Pocket Consultant Cardiology / "Swanton's Cardiology" is from 2008 (IMHO, too outdated to justify purchase). Having said that, one cool book which provides information not easily found elsewhere is Bedside Cardiology by Jules Constant - an extremely detailed book on the cardiac physical exam, which connects exam findings to pathophysiology. (To give you an idea of how detailed, there's an entire chapter for S3, and another for S4.) It's mostly esoteric and even more outdated than Swanton, but also really interesting - if you are into obscure cardiac physical signs!

[@nathanielgarcia7225]

Could you do a video on Toxic Metabolic Encephalopathy? I think my fiancé had that but there isn’t much info on it.

[@StrongMed]

First, I hope your fiance has recovered. There isn't much info on "toxic metabolic encephalopathy" because it's not really a diagnosis. It's really just a way of saying a person is confused or disoriented for a reason that exists outside of the brain - it could be sepsis, an electrolyte or acid-base disorder, thyroid or adrenal disease, autoimmune disease, etc... I think the term only persists, at least in the US, because "toxic encephalopathy" has an ICD10 code making it a "billable diagnosis" and because it's a catch-all term that consulting neurologists use in the medical chart to mean "I can't help here" before signing off of a case.

[@kellylewisfischer181]

I had PRES 3 times in 2019 and early 2020. The first time was really scary because my head hurt so bad. The second time I was unconscious for a few days and the third time wasn't as bad but still landed me in ICU. I still get focal seizures and some swelling om my head. They said it was from taking Amerge (for migraines)

[@sonupooja2023]

Pls suggest me what medications have you taken.

[@rahuldeokar9423]

Please let me know what medicine was preferred to control seizures and what if Anti Epilepsy drugs not working

[@bobbyjunior9680]

Do you have any problem with your walking?

[@bobbyjunior9680]

After you had

[@jenndesaulniers8049]

I was diagnosed with PRES in July 2020 and let me tell you it's no fun. Please listen to your body .... My was caused by a hypertensive crisis.

[@adi27588]

Take care bro.. My father too diagnosed with PRES reason is hyper tension... Blood pressure

[@user-vp3lw4eq4i]

Hello Jen, have your symptoms subsided or have you been offered treatment? They suspect I too have PRES

[@sandeepsingh-zs1ww]

How many days it's took to recover please🙏🏻

[@zoomezam9935]

have you recovered?

[@whitneehoopes5065]

My mom was just diagnosed with this today. Her blood pressure became so high that it swelled her brain, and she went unconscious. She was placed into an induced coma.

[@StrongMed]

Hoping for her quick recovery.

[@cyndeemccollough8703]

How is your mother now? Sending prayers

[@sandeepsingh-zs1ww]

How many days took to recover

[@samahmahmoud8578]

How is your mother now

[@miguelowen19]

I need help my dad was diagnosed with Pres and I need help Please how can i contact the doctor ?

[@StrongMed]

I'm very sorry, but I can't provide specific individualized medical advice here. At least in the US, the best way to reach the doctor for a hospitalized relative is to call the hospital, ask to be connected to the ward where the patient is located, and then ask to speak to the person's nurse. The nurse can pass on the message to the doctor that you would like to speak with them, but also, the nurse can give you an update on how the patient is doing and what the plan is for the day. I hope your father recovers quickly!

[@ayseakpnar6049]

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

[@StrongMed]

I hesitate to ever say something in medicine is *impossible*, but it would seem extremely unlikely to have PRES with multiple normal MRIs. A quick literature search didn't turn up any cases of PRES with normal MRI either. However, given that neuroimaging is central to the diagnosis of PRES, I can imagine that if cases of PRES with normal MRI did exist, they would almost certainly go unrecognized.

[@dailydoseofmedicinee]

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

[@workuabageda1623]

👏👏👏

[@kyssadianeminerales8539]

I was diagnosed with PRES after I gave birth last Nov.2021

[@asikaummkhalid]

I was also diagnosed with this syndrome immediately after giving birth... I was treated for two weeks.

[@jetsetter8541]

Very interesting presentation. Thanks very much for your efforts to make it available for us. Brain is fascinating organ as is whole human body. What causes PRES ??