PRES / RPLS

PRES: Posterior reversible encephalopathy syndrome
RPLS : reversible posterior leukoencephalopathy syndrome.

👉S/S HA, seizure, visual problems, drowsiness, Confusion, HTN,
normal exam ,
👉Causes: in eclampsia, SLE, porphyria, chemotherapy, transplant,
nasal decongestant, IVIG, postpartum, AGN.
👉increase capillary leakage, Hyperperfusion
👉Dx: MRI: white matter vasogenic abn in occipital, parietal area,T2 Flair HI. Can involve cerebellum, brainstem, occ c spinal cord. diff types ICH.
Opposite findings in acute CVA: DWI  hyperintensity ADC hypointensity.
MRI findings resolve w rx in days to weeks. If got CSF : high protein. CSF pleocytosis requires further w/u.
Rx:
👉Lower blood pressure 25% over 2-6 hrs. Consider: Labetalol, Nicardipime, Clevidipine

👉IV anticonvulsants needed for +/- 3 months. Levetiracetam, Lacosamide.

👉Stop or reduce Immuno suppressant Tacrolimus / Sirolimus.

Not a medical advice. Read up-to-date. Feel free to comment. Improve the blog. Help Learners.
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