In plain words
Posterior reversible encephalopathy syndrome, or PRES, is a pattern seen on brain imaging. Fluid collects in the back parts of the brain and causes swelling. It is linked to high blood pressure, , some medications, kidney disease, and other conditions. In pregnancy and the postpartum period, PRES can appear with a severe headache, confusion, vision changes such as blurred or lost sight, nausea, or seizures. Most people recover well when the cause is treated and blood pressure is controlled, but it can be serious. It needs prompt evaluation, usually with an MRI. PRES is not something a mother can tell on her own. A with vision changes, confusion, or a seizure needs emergency care now: call 911.
The deeper version
PRES is a clinicoradiological syndrome first described as reversible posterior leukoencephalopathy by Hinchey and colleagues (New England Journal of Medicine, 1996). Vasogenic edema, classically in the parieto-occipital white matter, is thought to follow failure of cerebral autoregulation at high perfusion pressure, with and inflammation also implicated. MRI shows T2 and FLAIR hyperintensity, often with posterior predominance, and this is the diagnostic basis. In the perinatal period PRES is strongly associated with preeclampsia and eclampsia, and reported frequency in preeclamptic women varies widely across series. The main controversy is how often PRES is a cause of rather than a parallel manifestation of the same endothelial injury, and whether MRI findings predict prognosis. Separating PRES from and is clinically important.
Where it comes up
- High blood pressure and preeclampsiaPregnancy: Your Body
- Postpartum preeclampsia: the warning signsPostpartum: Your Body
- Headaches and migrainesPregnancy: Your Body
- Headaches after birthPostpartum: Your Body
- Forgetfulness and brain fogPregnancy: Mind and Life
What mothers here say about posterior reversible encephalopathy syndrome
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Sources
- Hinchey J et al. — A reversible posterior leukoencephalopathy syndrome. New England Journal of Medicine (1996)
- American College of Obstetricians and Gynecologists — Committee Opinion 767: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period (2019)