Posterior Reversible Encephalopathy Syndrome: Patofisiologi, Manifestasi Klinis Dan Radiologis : Literature Review

Safat Wahyudi, Dinda Zahra Andiyani, Santo Fitriantoro

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Artikel ini bertujuan meninjau patofisiologi, manifestasi klinis, dan temuan radiologis Posterior Reversible Encephalopathy Syndrome (PRES) berdasarkan 43 artikel yang dipublikasikan dalam 15 tahun terakhir. PRES memiliki istilah lain yaitu reversible posterior leukoencephalopathy syndrome (RPLS), reversible posterior cerebral edema syndrome, posterior leukoencephalopathy syndrome, hyperperfusion encephalopathy, dan brain capillary leak syndrome. Hampir dalam dua dekade terakhir kasus PRES mulai banyak dideskripsikan pada serial kasus. PRES dikenali karena gejala klinisnya reversibel dan berdasarkan temuan brain imaging. Patofisiologi pada PRES belum sepenuhnya diketahui, namun disfungsi endotel berperan penting pada kelainan ini. Diagnosa PRES sebaiknya dipertimbangkan pada pada pasien dengan gejala neurologis akut dengan riwayat gagal ginjal, pasien dengan fluktuasi tekanan darah, riwayat penggunaan obat sitotoksik, kelainan autoimun, atau eklamsia. Temuan radiografis yang khas adalah edema vasogenik subkorteks bilateral yang membaik dalam hitungan hari atau minggu. Pada kebanyakan kasus, PRES menunjukkan perbaikan klinis dan radiologis spontan. Pada gejala yang ringan, mungkin hanya terjadi satu gejala seperti nyeri kepala atau kejang, dan pada radiologis menunjukkan area edema vasogenik atau bahkan normal. Pada kasus yang berat, PRES dapat menyebabkan morbiditas bahkan mortalitas, seperti perdarahan akut atau edema fossa posterior masif yang dapat menyebabkan hidrosefalus obstruksi atau kompresi batang otak. PRES merupakan sindrom yang underdiagnosed karena kurangnya kesadaran tenaga medis terhadap sindrom ini. Dengan meningkatnya ketersediaan dan kualitas imaging, kesadaran PRES oleh tenaga medis mulai meningkat. 


Kata Kunci


Disfungsi endotel; Edema vasogenik; Posterior Reversible Encephalopathy Syndrome

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Referensi


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DOI: https://doi.org/10.33024/jikk.v13i1.20830

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