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Posterior reversible encephalopathy syndrome is a clinicoradiologic syndrome characterized by seizure, headache, nausea, vomiting, altered mental status, visual disturbance, or visual loss, together with radiologic findings. Herein we reported a patient who was a 27-year-old foreign workman brought to the emergency ward with blurred vision in both eyes, neck pain, somnolence, and altered mental status. He had no known medical or family history. On his physical examination, his blood pressure was 190/100 mmHg and visual acuity of both eyes was decreased (visual acuity = 20/40 for both eyes). Although blood pressure was controlled by intravenous labetalol bolus, his symptoms did not improve. The result of his brain computed tomographic scan was normal, but in the brain magnetic resonance imaging, there were hyperintensities in the occipital lobe and right cerebellar hemisphere, suggesting posterior reversible encephalopathy syndrome. The findings from a complete blood count, biochemical testing, and renal, pelvic and abdominal ultrasound and also the calculated glomerular filtration rate values revealed that all were in favor of chronic kidney disease (hemoglobin level, 10.3 mg/dL; blood urea nitrogen, 90 mg/dL; Cr, 6.8 mg/dL; potassium, 5 mEq/L; sodium, 140 mEq/L; Cockcroft-Gault glomerular filtration rate, 15; weight, 65 kg). The hemodialysis was performed by which the sign and symptoms and radiologic findings resolved within 24 hours. Although PRES is described to be in association with many medical conditions, as mentioned in many available articles, we came to a conclusion that PRES could be the first presentation of a condition such as chronic kidney disease in our case.
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PMID:Posterior reversible encephalopathy syndrome as the first presentation of chronic kidney disease. 2434 63

A 59-year-old man with end-stage renal disease was brought to our emergency department with complaints of headache, nausea, dysarthria, tic, and weakness involving the bilateral arms and legs. He had the similar episode 4 month before, when he was treated elsewhere. The patient had received hemodialysis three times per week. His medications included for hypertension. On examination at his arrival, he was alert with reduced concentration and incoherent thoughts. The blood pressure was 181/87 mmHg and other vital signs were normal. Neurological findings showed slight dysarthria and slow movements but no other abnormalities. Laboratory data showed increased serum creatinine and potassium presumably for a session of periodical hemodialysis but normal sodium concentration. His cerebrospinal fluid examination was normal. We treated him by hemodialysis. Diagnosis of PRES was most likely because of the clinical features and the MRI findings. His symptoms had disappeared immediately and completely after we controlled high blood pressure. MRI on 13 days after admission showed the improvement of the abnormal findings. Although the pathophysiology of PRES is incompletely understood, renal failure was known as one of the risk factors. A relative lack of sympathetic innervation of posterior circulation could not protect the area when severe hypertension makes auto-regulatory control collapsed. However, PRES of the brainstem is uncommon although the posterior circulation involves it. Because control of his hypertension was not appropriate in the outpatient settings before this event, it could have contributed to the recurrence in this patient.
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PMID:Recurrent posterior reversible encephalopathy syndrome of the brainstem in a hypertensive patient with end-stage renal disease. 2511 39