Autonomic Dysreflexia and Posterior Reversible Encephalopathy Syndrome

Matias AC, Rocha JM, Cerqueira ME, Pereira JM: Autonomic dysreflexia and posterior reversible encephalopathy syndrome. Am J Phys Med Rehabil 2013;92:453-458. Autonomic dysreflexia is a syndrome of massive imbalanced reflex sympathetic discharge in patients who had a spinal cord injury above the splanchnic sympathetic outflow resulting in a sudden increase in blood pressure. Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiologic entity characterized by headache, consciousness impairment, visual disturbances, seizures, and posterior transient changes on neuroimaging (cerebral vasogenic edema). Hypertension is a common cause of PRES. The authors describe two case reports of patients with tetraplegia who developed PRES after an autonomic dysreflexia episode. One of them had recurrence of PRES in a similar clinical context. The authors discuss further aspects of PRES and its recurrence, which seems to be unusual particularly after autonomic dysreflexia.