Posterior Reversible Encephalopathy Syndrome (PRES)

Alternative Nomenclature



  • First Reported in 1996 as “Reversible Posterior Leukoencephalopathy Syndrome” by Hinchey (NEJM, 1996) [MEDLINE]
    • Nearly Half of the 15 Patients Reported were Receiving Immunosuppressive Therapy
    • Most of the Patients Had Impaired Renal Function


Renal Disease

Autoimmune Disease

  • Antiphospholipid Antibody Syndrome (see xxxx, [[xxxx]])
  • Autoimmune Hepatitis (see xxxx, [[xxxx]])
  • Cryoglobulinemia (see Cryoglobulinemia, [[Cryoglobulinemia]])
  • Goodpasture’s Syndrome (see xxxx, [[xxxx]])
  • Granulomatous Interstitial Nephritis
  • Grave’s Disease (see xxxx, [[xxxx]])
  • Hashimoto Thyroiditis (see xxxx, [[xxxx]])
  • Inflammatory Bowel DIsease
    • Crohn’s Disease (see xxxx, [[xxxx]])
    • Ulcerative Colitis (see xxxx, [[xxxx]])
  • Insulin-Dependent Diabetes Mellitus (IDDM) (see Diabetes Mellitus, [[Diabetes Mellitus]])
  • Neuromyelitis Optica
  • Polyarteritis Nodosa (PAN) (see Polyarteritis Nodosa, [[Polyarteritis Nodosa]])
  • Polyglandular Autoimmune Syndromes (see xxxx, [[xxxx]])
  • Rheumatoid Arthritis (RA) (see xxxx, [[xxxx]])
  • Scleroderma (see Scleroderma, [[Scleroderma]])
  • Sjogren’s Syndrome (see xxxx, [[xxxx]])
  • Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus, [[Systemic Lupus Erythematosus]])
  • Thromboangiitis Obliterans (see xxxx, [[xxxx]])
  • Thrombotic Thrombocytopenic Purpura (TTP) (see Thrombotic Thrombocytopenic Purpura-Acquired, [[Thrombotic Thrombocytopenic Purpura-Acquired]])
  • Wegener’s Granulomatosis (see Wegener’s Granulomatosis, [[Wegeners Granulomatosis]])


  • Bevacizumab (Avastin) (see Bevacizumab, [[Bevacizumab]])
  • Calcineurin Inhibitors
    • General Comments
      • Multiple Case Series Have Been Reported (Medicine, 2016) [MEDLINE] and (Transplant Proc, 2014) [MEDLINE]
      • May Be Associated with Calcineurin Levels Above or at the High End of Therapeutic Ranges, Although Cases Have Been Reported with Therapeutic Calcineurin Levels
    • Cyclosporine A (see Cyclosporine A, [[Cyclosporine A]]): commonly-reported etiology
    • Tacrolimus (FK-506, Fujimycin, Prograf, Advagraf, Protopic) (see Tacrolimus, [[Tacrolimus]]): commonly-reported etiology
  • Interferon Alfa
  • Intravenous Immunoglobulin (IVIG) (see Intravenous Immunoglobulin, [[Intravenous Immunoglobulin]])
  • Ipilimumab (MDX-101, MDX-010, Yervoy) (see Ipilimumab, [[Ipilimumab]])
  • Methotrexate (see Methotrexate, [[Methotrexate]])
  • Platinum-Based Agents
    • Carboplatin (see Carboplatin, [[Carboplatin]])
    • Cisplatin (see Cisplatin, [[Cisplatin]])
    • Oxaliplatin (Eloxatin, Oxaliplatin Medac) (see Oxaliplatin, [[Oxaliplatin]])
  • Pyrimidine Analogs
    • Cytarabine (Arabinofuranosyl Cytidine, ARA-C, Cytosine Arabinoside, Cytosar-U) (see Cytarabine, [[Cytarabine]])
    • Gemcitabine (Gemzar) (see Gemcitabine, [[Gemcitabine]])
  • Radiographic Contrast (see Radiographic Contrast, [[Radiographic Contrast]]): used for cerebral/coronary angiography
  • Rituximab (Rituxan) (see Anti-CD20 Therapy, [[Anti-CD20 Therapy]])
  • Sirolimus (Rapamune, Rapamycin) (see Sirolimus, [[Sirolimus]])
  • Tyrosine Kinase Inhibitors
    • Pazopanib (Votrient) (see Pazopanib, [[Pazopanib]])
    • Sorafenib (Nexavar) (see Sorafenib, [[Sorafenib]])
    • Sunitinib (Sutent) (see Sunitinib, [[Sunitinib]])
  • Vincristine (see Vincristine, [[Vincristine]])



Probable Mechanisms

Anatomic Distribution


Head CT (see Head Computed Tomography, [[Head Computed Tomography]])

Brain MRI (see Brain Magnetic Resonance Imaging, [[Brain Magnetic Resonance Imaging]])

Clinical Manifestations

Cardiovascular Manifestations

Neurologic Manifestations

Malignant Posterior Reversible Encephalopathy Syndrome


Treatment of Hypertension (see Hypertension, [[Hypertension]])

Treatment of Seizures (see Seizures, [[Seizures]])

Treatment of Eclampsia (see Pre-Eclampsia, Eclampsia, [[Pre-Eclampsia, Eclampsia]])

Management of Cytotoxic Thrapies