Progressive Posterior Encephalopathy Syndrome Related with Drug-refractory Hypertension in a Patient with Pheochromocytoma

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome characterized by headache, altered mental status, visual disturbance, and seizures with diagnostic MRI features, especially in the territories of posterior circulation. Reversibility of clinical and radiologic findings is generally regarded as a defining feature of PRES. Case Report: A 72-year old man who had a history of hypertension presented with subacute and progressive visual disturbance, dizziness, limb ataxia, and finally non-convulsive status epilepticus. Magnetic resonance imaging (MRI) showed extensive lesions in bilateral parieto-occipital cortex and subcortex. Due to his marked fluctuation of blood pressure, we detected a pheochromocytoma of left adrenal gland. In spite of administration with several types of antihypertensive medication, the patient presented with clinical deterioration, leading to death. MRI demonstrated the progression of lesions. Conclusion: This case report highlights the clinical and radiological progression of posterior encephalopathy syndrome caused by pheochromocytoma despite appropriate treatment of blood pressure. J Neurocrit Care 2014;7(2):141-144