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Posterior reversible encephalopathy syndrome (PRES) and infection: a systematic review of the literature

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is an encephalopathy characterized by a rapid onset of symptoms including headache, seizures, confusion, blurred vision, and nausea associated with a typical magnetic resonance imaging appearance of reversible subcortical vasogenic edema prominent and not exclusive of parieto-occipital lobes. Vasogenic edema is caused by a blood-brain barrier leak induced by endothelial damage or a severe arterial hypertension exceeding the limits of cerebral blood flow autoregulation. Although the exact pathophysiological mechanism is still unclear, frequent conditions that may induce PRES include severe hypertension, eclampsia/pre-eclampsia, acute kidney diseases and failure, immunosuppressive therapy, solid organ, or bone marrow transplantation. Conversely to other conditions, which may induce PRES, the link between severe infection or sepsis and PRES, often associated with gram-positive bacteria, is still poorly understood and less well known. Clinicians from multiple disciplines, such as neurologists and internists, may encounter during their profession patients with severe infection or sepsis and should consider the possible association between PRES and these conditions. We systematically reviewed the literature about this association in order to provide a helpful clinical insight of such complex pathophysiological mechanism, highlighting the importance of recognizing PRES in such a complex clinical scenario.

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  1. Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98100, Messina, Italy

    Sergio Racchiusa, Enricomaria Mormina, Antonietta Ax, Marcello Longo & Francesca Granata

  2. Department of Clinical and experimental Medicine, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98100, Messina, Italy

    Enricomaria Mormina & Olimpia Musumeci

Authors
  1. Sergio Racchiusa
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  2. Enricomaria Mormina
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  3. Antonietta Ax
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  4. Olimpia Musumeci
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  5. Marcello Longo
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  6. Francesca Granata
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Correspondence to Sergio Racchiusa.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not necessary because the present study consists of a literature revision.

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Racchiusa, S., Mormina, E., Ax, A. et al. Posterior reversible encephalopathy syndrome (PRES) and infection: a systematic review of the literature. Neurol Sci 40, 915–922 (2019). https://doi.org/10.1007/s10072-018-3651-4

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  • DOI: https://doi.org/10.1007/s10072-018-3651-4

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