The Association of Posterior Reversible Encephalopathy Syndrome with COVID-19: A Systematic Review

ABSTRACT

Objective: The increasing frequency of PRES during the COVID-19 pandemic, and a possible causal relationship between the two necessitates the review of available literature so that knowledge of practicing physicians is up to date in terms of the likely presentation and management of this clinical association. Background: The surge in COVID-19 cases is bringing with it an array of unique neurological manifestations. Clinicians report a possible association with Posterior Reversible Encephalopathy Syndrome (PRES). PRES is an otherwise rare disease that usually arises as part of greater complications such as hypertension and renal failure. Design/Methods: We conducted a systematic literature search on four databases namely PubMed/MEDLINE, Cochrane, Google Scholar, and ScienceDirect. A total of 34 articles describing 56 cases of PRES in COVID-19 were selected as a part of this review. Results: The mean age of the patients was 56.6 ± 15.3 years. The most common clinical presentation of PRES was altered mental status (53.6%) followed by seizures (46.4%) and visual disturbances (23.2%) while hypertension (28.6%) and diabetes mellitus (23.2%) were the most commonly reported predisposing comorbidities. 16.1% of the patients were treated for COVID19 with Tocilizumab, another predisposing factor for PRES. Symptomatic management was employed in most of the cases and 44 patients (78.5%) were reported to fully or partially recover. Conclusions: When COVID-19 is developed on a background of hypertension and diabetes, there is a possibility that all these factors play an additive role in the development of PRES. Therefore, neurologists and radiologists must consider PRES as a probable diagnosis when encountering COVID-19 patients with suggestive clinical and radiographic findings. The risk of using tocilizumab, a potential trigger of PRES, must be weighed against its potential benefit in mitigating the COVID-19 cytokine storm. Timely diagnosis and treatment report a good prognosis.