From the Narayana Super Speciality Hospital Guwahati, Assam, India.
Exp Clin Transplant. 2022 Jul;20(7):642-648. doi: 10.6002/ect.2021.0268.
Posterior reversible encephalopathy syndrome encompasses a spectrum of disorders with a constellation of clinical symptoms and neuroradiological features. It is commonly encountered in organ transplant where it poses a challenge in the diagnosis and treatment in the absence of strong evidence. The underlying pathophysiology of posterior reversible encephalopathy syndrome is the loss of cerebral autoregulation following elevated blood pressure and/or endothelial dysfunction. It is more likely to happen in patients treated with cyclosporine versus with tacrolimus. Posterior reversible encephalopathy syndrome manifests as headache, visual disturbances, seizure, and abnormal mentation. The characteristic radiological features are the result of posterior- circulation vasogenic edema secondary to blood-brain barrier disruption. Treatment varies based on the etiology of the condition. In addition to the symptomatic management of hypertension and seizure disorders, switching or replacing the calcineurin inhibitor with another immunosuppressant or decreasing the dose of the calcineurin inhibitor is the key in calcineurin inhibitor-associated posterior reversible encephalopathy syndrome. Here, we have reviewed the terminology, pathogenesis, clinical features, diagnosis, and treatment of posterior reversible encephalopathy syndrome with special reference to its presence in the posttransplant period.
后部可逆性脑病综合征（Posterior Reversible Encephalopathy Syndrome，PRES）是一种具有一系列临床症状和神经影像学特征的疾病谱。它在器官移植中较为常见，但由于缺乏强有力的证据，在诊断和治疗方面存在挑战。PRES 的潜在病理生理学是血压升高和/或内皮功能障碍导致的脑自动调节丧失。它更可能发生在接受环孢素治疗的患者中，而不是接受他克莫司治疗的患者中。PRES 的表现为头痛、视力障碍、癫痫发作和精神状态异常。特征性的影像学特征是血脑屏障破坏引起的后循环血管源性水肿的结果。治疗根据病因的不同而有所不同。除了对高血压和癫痫发作疾病进行对症治疗外，在钙调神经磷酸酶抑制剂相关的 PRES 中，将钙调神经磷酸酶抑制剂与另一种免疫抑制剂转换或替换，或降低钙调神经磷酸酶抑制剂的剂量是关键。在这里，我们回顾了后部可逆性脑病综合征的术语、发病机制、临床特征、诊断和治疗，特别提到了它在移植后时期的存在。
