Abstract
Posterior reversible encephalopathy syndrome (PRES) has several possible triggers, including severe hypertension. In such cases, blood pressure control is a key component of management. However, due in part to its rarity, the evidence regarding blood pressure targets in this condition is limited. In edge-cases of PRES, individualised blood pressure targets may be required.
Methods A case is described of a patient with PRES secondary to hypertension and required careful blood pressure management. The evidence regarding blood pressure management in PRES is reviewed.
Results A 52-year-old male presented to a tertiary hospital emergency department with vomiting and a 5-minute generalised tonic-clonic seizure. The day prior he described a headache and was agitated at dialysis. His past medical history hypertension and chronic kidney disease on haemodialysis. With the ambulance team his blood pressure was 205/110mmHg. He was drowsy and confused, with evidence of resolved epistaxis. Brain computed tomography demonstrated left frontal encephalomalacia from a prior insult. He remained confused, with a blood pressure of approximately 190/100mmHg despite oral medication until admission to the intensive care unit 24 hours later. Initial blood pressure target was 140–160mmHg systolic. Magnetic resonance imaging the subsequent day demonstrated subcortical T2 hyperintensities in occipital lobes, cerebellar hemispheres, and medial thalami, in keeping with PRES. A small left thalamic ischaemic stroke, left occipital intraparenchymal haemorrhage and multiple microhaemorrhages throughout the occipital lobes was seen. The blood pressure target was revised to < 140/80mmHg.
Conclusion PRES secondary to hypertension requires close blood pressure management, which may require individualised targets.
