While most cases of posterior reversible encephalopathy syndrome (PRES) occur in the setting of elevated blood pressure, a clinically important subset presents without hypertension. In these patients, the driving factor is an associated medical disorder or an exogenous triggering agent — and recognising that distinction directly shapes management.
This protocol covers PRES occurring without hypertension, where an associated medical disorder or a specific triggering agent is the precipitating cause. Identifying the underlying trigger is a necessary first step in this population before further management can be directed appropriately.
The central intervention is identification of the associated medical disorder or triggering agent. Where a precipitating agent is found — such as a chemotherapeutic drug — discontinuation or replacement of that agent is the key action.
The complete structured regimen, including full sequencing and additional interventions, is available through the link below.DOI: 10.1056/NEJMra2114482
In patients who have PRES without hypertension, it is necessary to identify associated medical disorders or triggering agents that are known to be associated with the condition (Tables 1 and 2).
Treatment of PRES is primarily directed at mitigation of hypertension, as discussed below; managing seizures, brain edema, and encephalopathy; or discontinuation or replacement of a precipitating agent (e.g., a chemotherapeutic drug).
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