What Is the Treatment of Reversible Posterior Leukoencephalopathy Syndrome?

Reversible posterior leukoencephalopathy syndrome (PRES/RPLS) requires prompt recognition and immediate action. The central objective is identifying and reversing whatever is driving the syndrome — before irreversible injury occurs.

Supportive Care & Precipitating Factor

Management is supportive. The first priority is identifying and removing or reversing the precipitating factor — this may include a causative medication such as a chemotherapy or immunosuppressive agent. Hydration and correction of electrolyte disturbances are also required as part of immediate management.

Acute Hypertension Management (Partial Overview)

When acute hypertension is present, the protocol calls for a structured, gradual reduction in blood pressure using first-line intravenous antihypertensive agents delivered by continuous infusion. The approach is carefully titrated to avoid overshoot and end-organ ischaemia.

Specific first-line agents, titration steps, and the full sequential algorithm are available in the complete structured protocol below.

Treatment Goals

Controlled blood pressure reduction — by no more than 20–25% within the first few hours — targeting a mean arterial pressure within the safe therapeutic range, without precipitating cerebral, coronary, or renal ischaemia.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/practneurol-2021-003194

The acute management of PRES is supportive and includes removing or reversing any suspected cause, for example, correcting hypertension.
It is essential to recognise the condition promptly and to remove or reverse the precipitating factor, including chemotherapy or an immunosuppressive agent.
Patients need to be hydrated and to have any electrolyte disturbances corrected.
Patients with acute hypertension should have their blood pressure gradually reduced by no more than 20%–25% in the first few hours to avoid the risk of cerebral, coronary and renal ischaemia.
Clinicians should aim for a mean arterial pressure of between 105 and 125 mm Hg, and continuous intravenous infusions are often required.

View source ↗