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PRES — RACP Adult Medicine MCQ

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HardNeurologyPRESRACP Adult Medicine

A 35-year-old woman with SLE presents with headaches, seizures, visual disturbance, and confusion. BP is 195/120 mmHg. MRI brain shows bilateral symmetrical white matter oedema predominantly in the parieto-occipital regions. What is the most likely diagnosis?

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Correct answer: B — Posterior reversible encephalopathy syndrome (PRES)

Headaches, seizures, visual disturbance, and confusion with parieto-occipital white matter oedema on MRI in the setting of severe hypertension and immunosuppressive therapy (common in SLE) is classic for PRES. Treatment is aggressive BP control and removal of precipitating factors (e.g., cyclophosphamide, tacrolimus). Most cases are reversible with prompt management.

Reference: eTG Neurology – 2024 – PRES; Fugate 2015 PRES Review