This study aims to review cases of posterior reversible encephalopathy syndrome (PRES) and/or reversible cerebral vasoconstriction syndrome (RCVS) that occur following blood transfusion.

PRES and RCVS are two distinctly underrecognized entities that can show similar clinical and imaging characteristics and risk factors and may be a part of a spectrum of vascular dysregulation. There have been multiple reports of PRES/RCVS following blood transfusion that should be reviewed for relevant conclusions. 

We conducted a systematic review of PubMed, Scopus, and Web of Science databases for detailed reports of blood transfusion-induced PRES/RCVS that were published until April 2025. Two authors independently screened the results, and a third author resolved the conflicts. We extracted data on demographics, transfusion details (type, volume, and duration), clinical symptoms, imaging findings, and management details. Pooled analysis was performed.

A total of 41 patients from 33 reports were included with a mean (SD) age of 43.27 (14.53) years, a female majority (96.56%), and a mean (SD) baseline hemoglobin of 2.85 (1.23) g/dL. The majority (95.12%) received packed red blood cells. The mean (SD) total volume transfused was 2100 (2560) ml over a median (IQR) duration of 2.50 (1 to 4) days. The most common symptoms were headache (75.61%), seizure (73.17%), visual disturbance (31.71%), and cognitive impairment (29.27%). Most patients (65.85%) experienced symptoms within one week. The most common imaging findings were subcortical edema (46.34%), cortical infarcts (34.15%), subcortical infarcts (26.83%), and cortical edema (19.51%). Regarding the conclusive diagnosis, 21 cases (51.22%) had PRES, nine cases (21.95%) had RCVS, and 11 (26.83%) had overlapping syndrome. While management has been mainly supportive, use of antihypertensive and anticonvulsant agents has been reported in 15 cases (36.59%) for each.

Our research reviews the reported cases of PRES/RCVS following blood transfusion and contributes to the current knowledge of such underrecognized conditions.