Posterior reversible encephalopathy syndrome (PRES)

The patient was a young woman who visited hospital for vertigo and nausea –vomiting. She had a history of CVA and ARF. In her systemic physical exam, the only positive point was high blood pressure. Her first brain CT had no significant point except a hypo density due to the previous CVA ,but After two days of hospitalization we performed another brain CT because of her complication of headache and confusion which showed hypo densities in both cerebellar hemispheres. In brain MRI (DW) signal changes in cerebellum did not match with an acute infarction. By control of BP, she showed improvements in clinical status and imaging. She discharged from hospital with diagnosis of PRES and great general status Case Report The patient was a young woman who visited hospital for vertigo and nausea –vomiting. She had a history of CVA and ARF. Her systemic physical exam only showed HTN. In neurological physical exam, she showed nystagmus in lateral gaze and an abnormal right-sided finger to nose test. In brain CT, an old infarct in left occipital lobe was remarkable. After two days of hospitalization, her brain CT showed hypo densities in both cerebellar hemispheres. In the same day the patient had a very severe headache without any changes in level of consciousness, so we request for a neurosurgery consult. In her brain MRI (TDW) signal changes in cerebellum did not match with an acute infarction. By control of BP, she showed improvements in clinical status and imaging. She discharged from hospital with diagnosis of PRES, blood pressure control and great general status.Conclusion Chronic kidney disease and acute kidney injury are both commonly present in patients with PRES, and PRES is strongly associated with conditions that co-exist in patients with renal disease, such as hypertension, vascular and autoimmune diseases, exposure to immunosuppressive drugs, and organ transplantation. It is therefore important to consider PRES in the differential diagnosis of patients with renal disease and rapidly progressive neurologic symptoms. Posterior reversible encephalopathy syndrome is an increasingly recognized disorder, with a wide clinical spectrum of both symptoms and triggers, and yet it remains poorly understood.

کلیدواژه ها:

PRES ، ARF ، HTN ، hypo dense lesions of cerebellum