PRES Syndrome
Common Risk Factors of PRES Syndrome
PRES Syndrome (Posterior Reversible Encephalopy Syndrome) is a radiologic condition. characterized by. a headache, seizure, altered mental status, vision loss,
PRES syndrome is commonly associated with. uncontrollable hypertension, renal disease, preeclampsia, autoimmune disorders, and cytotoxic medications
PRES syndrome typically presents on imaging studies as posterior-predominant white matter vasogenic edema
The pathology of PRES syndrome remains unknown, however there are two major theories that present in medical articles currently
Theory 1
elevated arterial pressure
those elevated arterial levels causes cerebral hyperperfusion.
cerebral hyperperfusion. causes the auto regulation system to be extremely over run
An over run auto regulation system causes stress on the blood brain barrier which causes vascular leakage
Theory 2:
cytotoxic injury causes endothelial dysfunction
With PRES syndrome, while seizures are common, epilepsy is extremely rare
Elevations of blood pressure
impaired renal function
pre eclampsia
eclampsia
autoimmune disease
infection.
TRANSPLANTS!!!!!
Chemotherapeutic agents
Diagnosis of PRES Syndrome
MRI
CT Scan.
There is no gold standard test for diagnosis of PRES syndrome because the syndrome is so rare and there is still so much to learn about PRES. syndrome
Classic imaging patterns reveals vasogenic edema that involves the Pareto-occipital regions, bilateral, subcortical, and symmetrical in apperance
Management of PRES Syndrome
Take out the trigger - typically this has todo with stopping the chemotherapy the patient is one
Supportive care with hydration
Treat the renal failure
Why all of this matters
8 months ago the patient was rushed to the ER following a car crash where they realized that the patient had a seizure. in the car
Within that same hospital. stay, they found renal failure and rhabdomylsis. For the last 8 months he has been seeing doctor after doctor trying to figure out what happened to him because he went from being a healthy college student to having renal failure, seizures caused by PRES syndrome, uncontrolled hypertension, and rhabdomylsis
PRES syndrome is commonly associated with uncontrollable hypertension.
Rhabdomylsis is is commonly associated with renal failure
Rhabdomylsis is a breakdown the muscle tissue that releases a damaging protein in the blood; many times patients with this condition with have extremely dark urine
This condition is commonly caused by trauma. This makes sense. because the patient has trauma (the car accident) which probably caused the rhabdomylsis
Because this condition releases damaging proteins into your blood and your kidneys filter blood, this protein typically can't be filtered by your kidneys which. is what would cause your kidneys to fail which explains this patients kidney failure that had not. occurred previously.
SO.... The crash. caused the rhabdomylsis, which caused the kidney failure and the PRES syndrome caused the seizure and the uncontrollable. hypertension, but what caused the PRES syndrome and the seizure to begin with you might ask??:
Welll, one of the risk factors of PRES syndrome is infection. The patient had no previous history of infections prior to this incident, however new literature as recently arisen on the intersection and connection between COVID. While the patient denied having ever been diagnosed with COVID, we know that COVID can be sneaky and be asymptomatic, so him being diagnosied officially with COVID. doesn't really rule out the possibility that COVID could have caused this
Today the patient was in the hospital presenting with a new rash which then had been diagnosed as petechia
petechiae are pinpoint round spots that appear on the skin as a result bleeding
Petechia can be due to a a blood clotting disorder
The patient currently presents with a low platelet count and his d dimer. was slightly. elevated in admission.
A common cause of press is thrombotic Throbocytopenic purpura
This is important because as a rurse I would probably request from the doctor a consult to Hemo as the patient seems to have signs of a blood disorder of some kind