PRES syndrome

Q: All of the following can be the symptoms of  reversible posterior leukoencephalopathy syndrome (RPLS) (PRES) except ?

A) Localized headache at the back of the head
B) Preceded by hypertensive crisis by 24 hours or longer
C) Anton's syndrome
D) Seizures
E) Altered consciousness


Answer: A

Headache in PRES syndrome is usually characterized as constantly moderate to severe, non-localized, and unresponsive to analgesia.

Anton's syndrome, also known as Anton–Babinski syndrome, is an interesting phenomenon in which despite presenting clear evidences to patients of their blindness, they remain adamant that "they can see". This is due to confabulation supported by fill in the missing sensory input.

Not necessarily but if present, the hypertensive crisis may precede other symptoms by 24 hours or longer.



References:

1. Stott VL, Hurrell MA, Anderson TJ. Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed. Intern Med J 2005; 35:83. 

2. Fugate JE, Claassen DO, Cloft HJ, et al. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 2010; 85:427. 

3. Lysandropoulos AP, Rossetti AO. Postictal cortical visual impairment: a symptom of posterior reversible encephalopathy. Epilepsy Behav 2010; 17:276.