PRES in the context of an infectious insult

Abstract

Introduction: Posterior reversible leukoencephalopathy syndrome is an acute/subacute clinical-radiological syndrome characterized by headache, changes in consciousness, seizures, focal neurological deficits, visual deficits and that may be preceded by uncontrolled blood pressure in the day before. It does not commonly occur concomitantly with prolonged infectious conditions. The most typical imaging finding is white matter edema in the posterior cerebral hemispheres. Treatment is based on adequate control of blood pressure and epileptic seizures, as well as metabolic and electrolyte control. The prognosis in most cases is excellent with significant improvement and complete reversal over days to weeks. Case report: Female, 37-year-old, after one month of underwent an endoscopic retrograde cholangiopancreatography was hospitalized due to a perirenal abscess, and treatment with antibiotics was initiated. During this treatment, she developed a sudden onset of bilateral amaurosis, continuous horizontal nystagmus, mental confusion, right upper limb weakness and hyperreflexia, in addition to an epileptic seizure and fencing response posture requiring intravenous phenytoin. Brain tomography demonstrated hypodensity in the occipital hemispheres and magnetic resonance imaging identified signal alteration in the white matter diffuse without diffusion restriction compatible with posterior reversible leukoencephalopathy syndrome. She evolved with adequate control of blood pressure and epileptic seizures, progressive improvement in visual acuity and muscle strength, until he returned to normality 10 days after the onset of symptoms. The antiepileptic drug was suspended, and she was discharged with antihypertensive medication. Conclusion: Posterior reversible leukoencephalopathy syndrome is an important differential diagnosis in conditions of sudden deficits and seizures, especially in this infectious context, because it is a reversible clinical condition with a good prognosis.