Posterior Reversible Encephalopathy Syndrome (PRES) is a common cause of ICU admission for seizure or altered mental status. Although PRES is commonly associated with hypertension, PRES can occur in the absence of hypertension due to a variety of disorders that impair endothelial function causing vasogenic edema. Thus, PRES encompasses the entity of “hypertensive encephalopathy” – but it is a much broader diagnosis than simply this phenomena.
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I have seen a pair of cases recently of severe PRES in patients with only mild hypertension(sbp 150-160s) but with significant etoh and benzo withdrawal. No other cause in either case as far as I could tell. There are some published case studies of PRES in Etoh withdrawal. Has anyone else seen this?