On the pathways of an imperfect chameleon: posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy (PRES) is a rare clinicoradiological syndrome characterized by a variety of neurological manifestations such as acute encephalopathy, headache, seizures, visual loss, and focal neurologic signs in association with a reversible and predominantly posterior leukoencephalopathy [1,2]. Although precipitated by severe hypertension in most cases, other conditions such as eclampsia, autoimmune disorders, renal failure, and drugs, for example, are now recognized to cause PRES [3]. The number of publications of PRES in the last years reﬂects the increasing recognition of the syndrome and also the availability of brain magnetic resonance (brain MRI) for urgent or emergency situations. However, because of its pleotropic clinical and radiological manifestations, the possibility of misdiagnosis should be considered [4]. Therefore, we decided to review and discuss our clinical experience in the diagnosis and management of this rare entity.