Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.
Department of Clinical and experimental Medicine, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.
Neurol Sci. 2019 May;40(5):915-922. doi: 10.1007/s10072-018-3651-4. Epub 2019 Jan 2.
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.
后部可逆性脑病综合征（PRES）是一种脑病，其特征为症状迅速发作，包括头痛、癫痫发作、意识混乱、视力模糊和恶心，伴有典型的磁共振成像表现为可逆性皮质下血管源性水肿，不限于顶枕叶。血管源性水肿是由内皮损伤或严重的动脉高血压引起的血脑屏障渗漏引起的，超过了脑血流自动调节的极限。尽管确切的病理生理机制仍不清楚，但可能诱发 PRES 的常见情况包括严重高血压、子痫/先兆子痫、急性肾疾病和衰竭、免疫抑制治疗、实体器官或骨髓移植。与可能诱发 PRES 的其他情况相反，严重感染或败血症与 PRES 之间的联系，常与革兰阳性菌有关，目前仍了解甚少，也鲜为人知。神经科医生和内科医生等多个学科的临床医生在其专业领域可能会遇到严重感染或败血症的患者，应考虑 PRES 与这些情况之间可能存在的关联。我们系统地回顾了关于这种关联的文献，以便为这种复杂的病理生理机制提供有帮助的临床见解，强调在这种复杂的临床情况下识别 PRES 的重要性。
