Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2025; 13(12): 98768
Published online Apr 26, 2025. doi: 10.12998/wjcc.v13.i12.98768
Corticosteroids in posterior reversible encephalopathy syndrome: Friend or foe? A systematic review
Bahadar S Srichawla, Taranjit Kaur, Harsimran Singh
Bahadar S Srichawla, Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
Taranjit Kaur, Department of Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, MS 39401, United States
Harsimran Singh, Department of Medicine, University of California Berkeley, Berkeley, CA 94720, United States
Author contributions: Srichawla BS was responsible for writing and editing of the manuscript, data collection, synthesis, analysis, intellectual conceptualization, and visualization of graphs; Kaur T and Singh H were responsible for data collection.
Conflict-of-interest statement: The authors report no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bahadar S Srichawla, DO, MS, Staff Physician, Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA 01655, United States. bahadar.srichawla@umassmed.edu
Received: July 4, 2024
Revised: October 24, 2024
Accepted: December 17, 2024
Published online: April 26, 2025
Processing time: 186 Days and 9.6 Hours
Abstract
BACKGROUND

Posterior reversible encephalopathy syndrome (PRES) is a complex neurological disorder characterized by symptoms such as headaches, seizures, confusion, and visual disturbances. The pathophysiology of PRES involves endothelial dysfunction, disrupted cerebral autoregulation, and resulting vasogenic edema. Hypertension and other factors that alter cerebral autoregulation are critical in its development. Corticosteroids, widely used for their anti-inflammatory and immunosuppressive properties, play a controversial role in PRES.

AIM

To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature. Specifically, it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES. By synthesizing case reports and series, this review aims to provide a comprehensive understanding of the mechanisms, clinical presentations, and management strategies associated with corticosteroid-related PRES.

METHODS

The review was carried out according to the PRISMA guidelines. The databases searched included Science Direct, PubMed, and Hinari. The search strategy encompassed terms related to corticosteroids and PRES. Studies were included if they were peer-reviewed articles examining corticosteroids in PRES, excluding non-English publications, reviews, and editorials. Data on patient demographics, clinical characteristics, imaging findings, corticosteroid regimens, and outcomes were extracted. The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.

RESULTS

A total of 56 cases of PRES (66.1% women, 33.9% men) potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified. Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years, with seizures, headaches, hypertension, and visual disturbances being common clinical sequelae. Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes. High-dose or prolonged corticosteroid therapy was a significant risk factor. On the contrary, in the treatment cases, corticosteroids were associated with positive outcomes, including resolution of vasogenic edema and stabilization of symptoms, particularly in patients with underlying inflammatory or autoimmune diseases.

CONCLUSION

Corticosteroids have a dual role in PRES, capable of both inducing and treating the condition. The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating. Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation. Corticosteroids may aid in the management of PRES: (1) Enhancing endothelial stability; (2) Anti-inflammatory properties; and (3) Improving blood-brain barrier integrity. Mechanisms which may reduce or mitigate vasogenic edema formation.

Keywords: Corticosteroids; Posterior reversible encephalopathy syndrome; Vasogenic edema; Reversible posterior leukoencephalopathy syndrome; Reversible cerebral vasoconstriction syndrome

Core Tip: Posterior reversible encephalopathy syndrome (PRES) is characterized by headaches, seizures, confusion, and visual disturbances due to endothelial dysfunction and vasogenic edema. Corticosteroids have a dual role in PRES, potentially inducing the condition through hypertension while also treating it by reducing inflammation and stabilizing the blood-brain barrier. This systematic review identifies 57 cases of corticosteroid-induced PRES and 14 cases where corticosteroids were used therapeutically. Understanding this dual role is crucial for optimizing patient care, highlighting the need for careful monitoring and tailored treatment strategies.