ASYMPTOMATIC SPINAL CORD INVOLVEMENT IN POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a reversible syndrome that presents with nausea and headache; altered consciousness; weakness; visual changes, including blurred vision or hemianopsia; seizures; and rarely coma.1 MRI demonstrates vasogenic edema, generally bilateral, predominant in the posterior parietal, temporal, and occipital regions of the brain. Commonly associated with severe acute hypertension, PRES is associated with eclampsia, renal failure, electrolyte disorders, hypocholesterolemia, drug abuse, infections, autoimmune diseases, and immunosuppressive and chemotherapy.1,2 ### Case report. A 39-year-old woman with untreated hypertension was admitted with headache, nausea, and vomiting. Three months before admission she had received radiation therapy for a single metastatic lesion in the odontoid process of a peritoneal leiomyosarcoma; 20 days before, she had completed a chemotherapy cycle with gemcitabine. She was drowsy with blurred vision. Blood pressure was 220/120 mm Hg and examination of optic fundus disclosed signs of hypertensive retinopathy. The examination was otherwise unremarkable, with flexor plantar responses. Blood tests were normal. Spectral attenuated inversion recovery MRI sequences showed large, confluent, bilateral, mostly symmetric hyperintense regions in the white …