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Sir,
Posterior reversible encephalopathy syndrome (PRES) as the name suggests, is a group of symptoms caused by reversible ischemia most commonly of the posterior cerebral vasculature. [1] However, as described by Kapoor et al. [2] in their case report that the condition PRES may not always be reversible and the term PRES may be a misnomer.
Death has been reported in up to 15% of patients of PRES. [3] Poor prognostic indicators in PRES include Extensive lesions, extension of edema, brain herniation, cytotoxic edema on diffusion-weighted imaging, and the presence of hemorrhages. [4] The patient mentioned by the author′s Kapoor et al. [2] had extensive lesions on magnetic resonance imaging as the poor prognostic marker in PRES and may be the reason that the patient succumbed to his illness.
Some authors suggest that a better name may be "PRES" instead of "PRES." [5] It is true that PRES is reversible if promptly recognized and adequately treated for most patients. However, it is not a rule and some patients may have an adverse outcome, in spite of a prompt correct therapy. [6]
Hedna VS, Stead LG, Bidari S, Patel A, Gottipati A, Favilla CG, et al. Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes. Int J Emerg Med 2012;5:12.
Kapoor A, Kumar V, Beniwal S, Dutta S, Goyal S, Kumar HS. Posterior reversible encephalopathy syndrome in non-Hodgkin′s lymphoma: Not necessarily reversible! Clin Cancer Investig J 2015;4:226-9.
Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg 2010;112:886-91.
Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: Fundamental imaging and clinical features. AJNR Am J Neuroradiol 2008;29:1036-42.
Narbone MC, Musolino R, Granata F, Mazzù I, Abbate M, Ferlazzo E. PRES: Posterior or potentially reversible encephalopathy syndrome? Neurol Sci 2006;27:187-9.
Antunes NL, Small TN, George D, Boulad F, Lis E. Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol 1999;20:241-3.
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