Reversible posterior encephalopathy syndrome induced by drug intoxication: A case report

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare complication of a sudden rise in blood pressure. It is seen in hypertensive patients. It is a clinical–radiological entity characterized by the association of neurological clinical signs and bilateral posterior cerebral edema usually reversible in neuroimaging. According to the literature, it is quite common in adults than in children. The most common causes are hypertensive encephalopathy, renal failure, central nervous system vasculitis, electrolyte disturbances, or when using cytotoxic or immunosuppressive therapies. It is clinically manifested as headache, seizures, coma, or visual disturbances. Imaging plays an undeniable role in the diagnosis and surveillance and cerebral magnetic resonance imaging (MRI) reveals bilateral and asymmetrical lesions affecting the basal ganglia, the left frontal lobe and the parietal lobes, in the form of hyperintensities in sequences. T2 and fluid-attenuated inversion recovery (FLAIR) imaging lead to vasogenic edema. The treatment of the basic pathology is the key to the reversibility of this syndrome. We report this article with the aim of retrieving and demonstrating the interest of imaging as part of a diagnostic approach and monitoring of PRES in a 54-year-old subject followed for schizophrenia and arterial hypertension under neuroleptic treatment having presented seizures with high blood pressure after 10 days of this neuroleptic treatment. The clinical course is favorable without recurrence of crisis with disappearance of the lesions on the imaging of the control after the interruption of the neuroleptics and the normalization of the arterial tension, living and asymptomatic patient on a retreat of one year.