Posterior Reversible Encephalopathy Syndrome Syndrome Research Articles

A RARE CAUSE OF ENCEPHALOPATHY IN CHILDREN: PRES SYNDROME

Background: Major clinical symptoms of posterior reversible encephalopathy syndrome include headache, mental status changes, visual disturbances, seizures, especially in the posterior cerebral region, and radiographic findings of vasogenic edema, especially in the posterior cerebellar region. Case Report: We present our 6-year-old patient with chronic renal failure. admitted to our pediatric emergency department with an acute hypertensive crisis. Generalized tonic-clonic seizures and mental status changes were accompanied in the follow-up of the patient whose GCS was 11; With symptomatic treatment, regression in both clinical complaints and imaging findings of our patient is consistent with Posterior reversible encephalopathy syndrome (PRES). Conclusion: It is imperative to consider PRES syndrome as a differential diagnosis when pediatric patients exhibit symptoms of acute encephalopathy. It is crucial to emphasize the critical nature of early diagnosis and treatment, as well as the potential for complete recovery without sequelae.

Posterior Reversible Encephalopathy Syndrome with Addison’s Disease in a Known Case of Arnold Chiari Malformation

Posterior Reversible Encephalopathy Syndrome (PRES) is a life-threatening neurological disease. The aetiology of Addison’s disease has been modified from infectious to autoimmune pathology. Underlying pathogenesis is insufficient production of glucocorticoids and mineralocorticoids. Case series with PRES syndrome and Cushing’s syndrome have been reported but PRESS with adrenal insufficiency is rarely published. We hereby report an operated case of Arnold Chiari malformation presenting with first episode of generalised tonic clonic seizure and diarrhoea for four days. Postictal confusion was present for two hours. She was previously diagnosed with Addison’s disease. Patient had hypotension and dyselectrolytaemia. Systemic examinations were within normal limits. MRI brain revealed features of PRES. The authors encountered certain challenges in her management which included persistent hypokalaemia, hypocalcaemia and hypotension. Patient is on regular follow-up and she is currently asymptomatic. Prompt diagnosis of PRES and intensive case treatment is a must for the betterment of prognosis.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME DUE TO HIGH BLOOD PRESSURE PEAK AFTER HEART TRANSPLANT

Objective: Posterior reversible encephalopathy syndrome (PRES) is a reversible subcortical vasogenic cerebral oedema involving parieto-occipital regions in patients with acute neurological symptoms. The aim of this study is to analyse an interesting case of PRES after heart transplant. Design and method: A heart transplant was performed in a 53-years-old woman affected by arrhythmogenic cardiomyopathy. She had history of atrial fibrillation and ventricular fibrillation requiring an implantable cardioverter defibrillator, chronic renal insufficiency with frequent acute episodes, heart failure and stasis hepatopathy. After the transplantation, the patient required femoral extracorporeal membrane oxygenator for three days, mediastinal revision for bleeding, two runs of continuous veno-venous hemofiltration, and a pericardial drainage for effusion. After fifty days the patient was stable, but she suddenly experienced a high blood pressure peak of 180 mmHg and tachycardia, followed by limb stiffening, limb colonies resolved with diazepam, verbal blockade, and sphincter release. Results: A cerebral computer tomography was immediately performed showing a bilateral parieto-occipital oedema suggestive of PRES (Figure 1). The patient was treated by brivaracetam and the immunosuppressive therapy was switched from cyclosporine to tacrolimus. Subsequently, she experienced amelioration of symptoms. Ten days later, electroencephalography did not show any epileptic signs and oedema was regularly evolving on cerebral imaging. PRES usually appears in the setting of blood pressure fluctuations, cytotoxic drugs, and renal failure. In the case presented, the time link between symptoms and typical brain images could show that the high blood pressure peak after heart transplant could have been a trigger for the syndrome in a patient with chronic renal disease treated with cyclosporine, which are both risk factors for PRES. According to literature, PRES syndrome could be due to endothelial injury related to abrupt blood pressure changes, breaking down blood-brain barrier and generating cerebral oedema. Conclusions: This case showed that PRES is a possible complication after heart transplant in patient with predisposing risk factors and blood pressure sudden variations. It is very important to have a good blood pressure control after heart transplant and to choose the property immunosuppressive therapy in these patients.

Pres associated with naltrexone implant

Posterior reversible encephalopathy syndrome (PRES) has been defined as a neurological syndrome diagnosed with a combination of clinical and neuroimaging findings. A 31-year-old female patient with no known history of the neurological disease was diagnosed with PRES as a result of physical examination and imaging. The patient had no other findings other than heroin use and related naltrexone implant. Although it has been reported that PRES is caused by various etiological reasons; no information has been found about whether it will be related to the naltrexone implant used in the treatment of people addicted to heroin. With this case, we wanted to remind PRES again and state that naltrexone implant, which we have not seen before in the literature, may also be in the differential diagnosis. Keywords : Emergency service,epileptic seizures,PRES syndrome,naltrexone implant

Abstract P122: Posterior Reversible Encephalopathy Syndrome Following Moderna M-RNA Booster Vaccination Secondary To Hypertension Vs Vaccine Adverse Effect?

Clinical Case: A 76-year-old female presented to our ED with acute onset confusion, unsteady gait and blurry vision within 24 hours after receiving the m-RNA Moderna booster vaccine. Medical history: notable for uncomplicated hypertension on metoprolol. She was awake, oriented intermittently x 3, with periods of confusion, blurry vision and intermittent unsteady gait and normal speech without any focal motor or sensory deficits. BP=192/80 mmHg bilaterally. Labs: showed hypercalcemia with elevated vitamin D 25-OH. Hypertension was managed with home dose of metoprolol succinate 150 mg/day and hypercalcemia improved with IV fluids. On Day 3 the patient was found lying in bed unresponsive to sternal rub with motor twitching of left arm, seizure like activity. Transfer to ICU for BP =185/104mmHg, T = 100.8 F, airway protection and treatment with diazepam. Empirical antibiotics were started for presumed encephalitis. EEG demonstrated seizure foci in bilateral posterior quadrants. MRI imaging on day # 3 showed T2/FLAIR hyperintensities in the parieto-occipital lobes and pulvinar of the thalami suggestive of posterior reversible encephalopathy syndrome (PRES). Discussion: PRES syndrome is both a clinical and radiological diagnosis with neurological changes coupled with MRI FLAIR hyperintensities in the parietal, occipital and frontal bilateral areas. This condition has been associated with uncontrolled hypertension, endothelial injury and side effect from certain drugs. Her hypertension was aggressively managed with amlodipine, enalapril, and IV metoprolol to decrease cerebral perfusion pressure. Repeat MRI imaging on day #14 demonstrated resolution of the hyperintensities without episodic blurry vision, confusion and our patient's mentation improved. At her 7 weeks follow our patient continued to have residual deconditioning and could only follow 2 step commands. We emphasize the importance of timely diagnosis with MRI imaging and preventing delay in management with adequate anti-hypertensives to prevent irreversible neurological damage from PRES syndrome. We also encourage reporting similar findings to VAERS as we are unable to exclude a reaction to her m-RNA vaccine booster.

Maternal and Perinatal Outcome of Posterior Reversible Encephalopathy Syndrome (PRES) in Patients with Eclampsia at Tertiary Health Care Centre.

Posterior reversible encephalopathy syndrome (PRES) and the related term reversible posterior leukoencephalopathy syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. Eclampsia associated with PRES is a rare condition and remains a challenging diagnosis to make. There are only a few studies regarding PRES syndrome with a limited sample size. Our institution is a tertiary referral centre; hence, a good sample size of patients with eclampsia complicated with PRES syndrome is seen in our study. The objective was to identify the maternal and neonatal outcomes in PRES with eclampsia. This study is a prospective observational study done in Government Medical College, Aurangabad, India from October 2018 to September 2020. In the present study, we have enrolled 63 cases, who satisfied inclusion and exclusion criteria during two years. All women admitted in the labour room of tertiary health care centre diagnosed with eclampsia with neurological symptoms during the study period were studied. Relevant data were obtained from the case file and compiled by common proforma. Analysis was done by SPSS (Statistical package for social sciences) Version 25th. In patients with a confirmed diagnosis of PRES with eclampsia(n = 63), the mean age of the patient was 20.74 ± 2.04years, 23 (36.5%) patients had headache as premonitory symptoms, whereas 13(20.6%)patients had visual disturbances as the premonitory symptom. The mean gestational age at presentation was 34.4 ± 2weeks. 40(63.5%) patients were showing parieto-occipital region changes, and 24(38.1%) subjects were showing only occipital region involvement in CT brain. 12 (19.04%) subjects were diagnosed with HELLP syndrome as a maternal complication, 07 (11.1%) subjects had Abruptio placentae. 26(41.3%) babies needed NICU admission, and 4 (6.3%) babies had neonatal death. In pregnant patients presenting with seizure and neurological symptoms, a possibility of PRES should be considered. Proper diagnosis requires careful attention to clinical and radiographic presentation. In eclampsia with PRES patients, a timely intervention with anti-hypertensive, anti-cerebral oedema measures as well as management of other associated symptoms are required. The online version contains supplementary material available at 10.1007/s13224-021-01585-9.

Posterior Reversible Encephalopathy Syndrome: An Unusual Complication of Benzodiazepine Poisoning: A Case Report

Posterior Reversible Encephalopathy Syndrome (PRES), also known as Reversible Posterior Leukoencephalopathy Syndrome, presents with rapid onset symptoms, including headache, seizures, altered consciousness, and visual disturbance. It is seen most frequently in settings of acute hypertension and is usually related to eclampsia. Only a few cases in the literature described PRES syndrome following benzodiazepines. We present a young male with benzodiazepine poisoning brought to the hospital in a deep coma, hypoxia, acidosis, and shock. Diagnosis of PRES was made on history, clinical examination, and radiologic findings of symmetric bilateral hyperintensities on T2 weighted Magnetic Resonance Imaging (MRIs) representing vasogenic edema.

Posterior Reversible Encephalopathy Syndrome: An Unusual Complication of Benzodiazepine Poisoning: A Case Report

Posterior Reversible Encephalopathy Syndrome (PRES), also known as Reversible Posterior Leukoencephalopathy Syndrome, presents with rapid onset symptoms, including headache, seizures, altered consciousness, and visual disturbance. It is seen most frequently in settings of acute hypertension and is usually related to eclampsia. Only a few cases in the literature described PRES syndrome following benzodiazepines. We present a young male with benzodiazepine poisoning brought to the hospital in a deep coma, hypoxia, acidosis, and shock. Diagnosis of PRES was made on history, clinical examination, and radiologic findings of symmetric bilateral hyperintensities on T2 weighted Magnetic Resonance Imaging (MRIs) representing vasogenic edema.

DRAWING THE CURTAINS: A CASE OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) POST UPPER GI ENDOSCOPY

Posterior reversible encephalopathy syndrome (PRES) is a devastating condition with distinct clinical and radiological manifestations. Clinical features vary from acute illness with symptoms of transient headache, changes of mental status, seizures, and visual loss. Radiological features associated with PRES include extensive white matter changes mainly in posterior and parietal lobes consistent with brain oedema 1,2. Clinical Case A57-year-old man with oesophageal stricture presented to Endoscopy Unit planned for Upper GI Endoscopy and oesophageal dilatation. He has background history of benign stricture, GORD, and CLL. After the procedure, patient had low blood pressure associated with headache followed by sudden loss of vision and seizure. Urgent referral to Anaesthesia and on call medical team were requested. Initial CT Angiogram showed no intra or extracranial atheromatous disease and patent vertebra-basilar system. This was followed with MRI scan which showed high signal on diffusion with cerebellar and occipital hemispheres bilaterally with results favouring vasogenic PRES syndrome. Due to patient condition, he was admitted to ICU and treated medically with amlodipine and levetiracetam. Patient’s symptoms gradually resolved with medical treatment and was discharged home after a week. Patient was then seen in outpatient clinic and was doing well. No further symptoms. As patient requiring repeated Endoscopy and dilatations, further procedures were conductedunder GA. No intra or post procedural complications were observed. Conclusion Patients who develop PRES could have catastrophic neurological complications. Hence, high level of suspicion for PRES must be considered in patient who develops altered mental status, seizures and acute visions with hypertension post endoscopic procedure or administration of medications. The gold standard diagnostic imaging is MRI. Blood pressure control and discontinuation of any causative agents is the treatment.

Posterior reversible encephalopathy syndrome (PRES): A rare disease; review of literature

Posterior reversible encephalopathy syndrome (PRES) is a complex multifactorial disorder diagnosed by clinical symptoms and radiological features. Clinically it presents with headache, diminution of vision, altered mental status, seizures and prolonged comatose state. Diagnosis is confirmed by brain imaging studies (CT/MRI) by presence of vasogenic edema of white matter in parietal and occipital lobes. It is commonly seen in young aged adults with female preponderance. Most commonly it is seen in woman with hypertension and preeclampsia/eclampsia. Early diagnosis and prompt treatment helps in better management of syndrome and thereby preventing the permanent complications. Authors here review the literature via discussing a case of 20 year old pregnant woman who came with ante partum eclampsia and was diagnosed with PRES syndrome. Keywords: Eclampsia, Encephalopathy, Headache, Preeclampsia, PRES.

Posterior Reversible Encephalopathy Syndrome (PRES) in Rheumatic Autoimmune Disease.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity with many causes. The primary abnormality is cerebral vasogenic oedema. Here we describe the management of five patients with PRES syndrome who presented to our hospital.LEARNING POINTSPosterior reversible encephalopathy syndrome (PRES) presents with cerebral vasogenic oedema.PRES resolves when blood pressure is controlled.Patients with a history of autoimmune disorder who present with confusion may have PRES.

Imaging feature in PRES syndrome: Report of 6 cases

Objectives Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome. The pathophysiology is poorly understood. Computed tomography (CT) and magnetic resonance imaging (MRI) findings are characteristic of the diagnosis and diffusion weighted image has been also suggested having a prognostic value. We report this unusual neurologic complication of peripartumin except any pre-existent pathology of the pregnancy. Materiel and methods CT, MR findings and relevant clinical data of the patients were retrospectively reviewed on 5 cases between 2011 and 2012 in our radiologic department. Results Eclampsia was responsible in all cases. CT finding were bilaterally symmetric low density in the posterior parietal and occipital lobes consistent with vasogenic edema on FLAIR and diffusion MR images ( Fig. 1 , Fig. 2 ). Conclusion Since PRES is often unsuspected by clinicians, radiologists may be the first to suggest the diagnosis. As this diagnosis has important therapeutic and prognostic implications, radiologists should be aware of the spectrum of imaging findings in PRES. It consists on an increasingly recognized neurologic disorder with characteristic CT and MR findings.

Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

Abstract Introduction HELLP syndrome (acronym comprised of hemolysis, elevated liver enzymes and low platelets) is seen in 0.1% of pregnant women. Posterior reversible encephalopathy syndrome (PRES) was reported to be 5% in patients with the HELLP syndrome. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI. Aim We aimed to improve clinicians’ perception about brain lesions in the HELLP syndrome with imaging findings. Case study Here, we present a case of an 18-year-old patient with a pregnancy of 24 weeks admitted with HELLP syndrome, with CT and MRI findings of PRES and intracerebral hematoma. MRI scan of the brain showed vasogenic edema in the occipital, frontal and parietal lobes bilaterally, basal ganglia and brainstem. An emergency cesarean section was successfully performed to end the pregnancy on the same day. Repeat MRI of the brain three days after initial admission showed partial improvement of the previous abnormalities with full clinical recovery. Results and discussion The patient in this report had a variant form of PRES where the pathologic process encompassed both the posterior and anterior circulations. Conclusions An appropriate multidisciplinary approach is the key for reducing the morbidity and mortality of PRES syndrome.

A Study of Eclampsia Cases Associated with Posterior Reversible Encephalopathy Syndrome.

Incidence of eclampsia is 1 in 2000 to 3250 deliveries in developed countries and 1 to 5% in India. Posterior reversible encephalopathy syndrome (PRES) is a constellation of symptoms caused by reversible ischaemia mostly of the posterior cerebral vasculature. PRES has been associated with preeclampsia-eclampsia and acute renal injury. We present a study of patients in whom eclampsia was complicated with PRES. Our aim was to study the clinico-radiological profile, associated complications and outcome of patients who had eclampsia with PRES. A retrospective study was done of all pregnancies diagnosed as eclampsia with PRES syndrome over a four year period from August 2010 to July 2014 managed at Karnataka institute of medical sciences, Hubli, India. Eleven patients had eclampsia with PRES syndrome of the 36,094 patients delivered in the institution over the study period. Nine of these were primigravidas, 8 were of 20-25 years age group, 10 presented with multiple seizure episodes. In eight patients seizures were controlled only with MgSo4. Perinatal mortality was seen in three patients. There were no maternal deaths in these cases. Incidence of eclampsia with PRES syndrome was 0.03% amongst the patients delivered in Karnataka institute of medical sciences. The incidence of PRES was more amongst cases of postpartum eclampsias as compared to antepartum eclampsias. PRES was more common in primigravidas and younger age group (20 to 25 years). Signs of imminent eclampsia like headache, epigastric pain and blurring vision were uncommon in these patients. In the majority of the patients seizures were controlled with MgSo4 alone. Prognosis of eclamptic patients with PRES was favourable.

Clinical profile and outcome of posterior reversible encephalopathy syndrome (PRES)

Background: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiographic syndrome of multiple etiologies. Still, the exact pathophysiology of PRES is not clear. Aims and Objectives: To study demographic, etiological, and clinic-radiological profiles of patients presenting with PRES and their outcome at the tertiary care teaching hospital. Materials and Methods: A retrospective observational and non-interventional study was conducted at tertiary care center in from January 2009 to December 2013 at Krishna Institute of Medical Sciences, Karad. Inclusion Criteria: The clinical history of acute neurologic change including headache, encephalopathy, seizure, visual disturbance, or focal deficit with magnetic resonance imaging (MRI) brain imaging findings of focal vasogenic edema with clinical or radiologic proof of reversibility. Results: Of a total 43 patients with suspected diagnosis of PRES, 29 patients were included fulfilling all inclusion criteria of PRES. Of total the 29 patients with confirmed diagnosis of PRES, 22 (75.86%) were female and 7 (24.13%) were male patients, predominated by female population (relative risk [RR]: 3.14; odds ration [OR]: 9.87; 'P' < 0.001). The overall mean age was 33.65 years (±15.26) and mean duration of stay was 10.13 days (±4.98). The most common clinical presentation was generalized tonic-clonic seizures, seen in 23 (79.31%) patients, headache in 21 (72.41%) patients, and visual disturbances 13 (44.82%) patients. A total of 18 (62.06%) patients were hypertensive and 11 (37.93%) were normotensive [RR: 1.63]. A total of 6 (27.27%) females and 5 (71.42%) males were normotensive and total 16 (72.72%) females and 2 (28.57%) males were hypertensive (RR: 1.12). Of a total of 22 female patients with PRES, 19 (86.36%) were in a postpartum state, one (4.45%) had systemic lupus erythematous (SLE), one (4.54%) had community-acquired pneumonia (CAP) with acute respiratory distress syndrome (ARDS) with septicemia and one (4.54%) had chronic hypertension in accelerated phase. Postpartum state was significantly associated with PRES ('P' < 0.001). A total of 15 (68.18%) female patients had pregnancy-induced hypertension (PIH)/eclampsia. Of a total of 7 male patients with a diagnosis of PRES. two (28.57%) were had chronic kidney disease (CKD), two (28.57%) had chronic hypertension, one (14.28%) had alcohol intoxication, one (14.28%) had rheumatoid arthritis (RA), and one (14.28%) had septicemia with septicemic shock. Of a total three (10.34%) deaths, two were females (6.89%) and one (3.44%) was male. Total 26 (89.65%) patients were discharged after successful treatment. A total of three patients succumbed during treatment with case fatality rate of 10.34% (RR: 1.06). The most commonly involved location was the parieto-occipital and cerebellum brain region, which was seen in 23 (79.31%) patients and the lesions were asymmetric in 27 (93.10%) and symmetric in 2 (6.89%) cases. All 29 (100%) patients had bilateral affection. Conclusion: The present study revealed the significant numbers of patients in postpartum state with PRES syndrome with good prognosis. The present study highlighted affection of young, female population with history of hypertension with predominant affection of parieto-occipital and cerebellar involvement in PRES. Autoimmune disease, infection, alcohol intoxication, and CKD were less common factors associated with PRES. The history of hypertension in clinical scenario with neuro-imaging, we should consider the possibility of PRES and aggressively treat based on the clinical presentation. Brain imaging plays an important role in diagnosis of PRES. The early diagnosis, prompt treatment including maintenance of hydration control of blood pressure and seizure and removal of precipitating factors is mandatory for a good outcome of PRES with minimal or no residual neuro-deficit.

My Headache is not Migraine

Introduction: Reversible posterior Leukoencehalopathy syndrome (RPLS) or PRES (Posterior Reversible Encephalopathy Syndrome) is a clinical radiographic syndrome of heterogeneous etiologies. A 46 year old female with past medical history of chronic pain, chronic pancreatitis, hypertension, anxiety, fibromyalgia and migraines with multiple admissions in the last 3 months for acute migraine attacks presented with headache. It started 3 days ago with typical involvement of frontal region along with nausea and non-bloody emesis. Headache was accompanied by diffuse abdominal pain 10/10 with no diarrhea or fever. She was unable to take her medications due to persistent vomiting episodes. She denied any focal weakness, tingling, numbness or vision problems. At presentation in emergency room, her systolic blood pressure was >200 and heart rate of 120. She was given intravenous hydralazine along with intravenous dialudid. She was about to be transferred to medical floor when she had blurry vision and later was unable to seen anything. Later she developed generalized tonic clonic seizures lasting less than 30 sec, responded well to intravenous valium. Her initial labs were normal in ER. An urgent MRI Brain showed interval development of non-enhancing bihemispheric and bilateral cerebellar hyper intense foci likely reflective of posterior reversible encephalopathy syndrome with no evidence of acute cerebral infarction or intracranial brain lesions (Figure 1a and 1b). The patient was started on patient controlled analgesia for control of migraine headaches and abdominal pain was attributed to opioid withdrawal given her normal labs. She did very well with control of blood pressure and outpatient MRI few weeks later showed reversal of MRI changes. PRES syndrome is a well-known condition which is under diagnosed and can be easily missed in presence of other conditions like Migraine and is really easy to miss. Early recognition and removal of precipitating factors is key to treat and prevent neurological compromise

Occipital lobe epilepsy secondary to Posterior Reversible Encephalopathy Syndrome (PRES) during a post-partum eclampsia in Mali (West Africa)

BackgroundEclampsia is known to cause posterior reversible encephalopathy syndrome (PRES) that is often associated with an extensive neurovascular damage affecting preferably posterior regions, often leading to reversible cortical blindness. In spite the magnitude of these lesions, post eclamptic symptomatic epilepsy is rare. We therefore report a case of symptomatic occipital lobe epilepsy secondary to PRES.Case presentationA 39-year-old female right handed teacher who presented with headache of progressive onset, phosphenes, rapid decline of visual acuity to blindness, vomiting, repeated generalized tonic-clonic seizures followed by altered consciousness and very high blood pressure (HBP) of 240/120 mmHg, all of which started about 12 hours following a normal delivery. Nine months later, the patient presented with paroxysmal visual symptoms predominating in the right visual field followed by partial tonic clonic seizures with secondary generalization and recurrence of partial occipital lobe seizures. The pathophysiologic mechanism of irreversible tissue damage during PRES syndrome could result from a combination of events including the delay for early treatment, inadequate antihypertensive drugs that could worsen the brain damage by hypo perfusion, inadequate or delayed treatment for seizures or status epilepticus.ConclusionDespite its high incidence in the third world, eclampsia is not a usual cause of epilepsy. Our case is the first description of post eclamptic occipital lobe epilepsy in Africa. With this report, we draw practitioners’ attention on this rare complication.

Asymmetric posterior reversible encephalopathy syndrome in patient with hyperplastic anterior choroidal artery

We describe a case of asymmetric PRES due to the presence of hyperplastic anterior choroidal artery (AChA) in a man affected by sever hypertension. Posterior reversible encephalopathy syndrome (PRES) has become synonymous with a unique pattern of brain vasogenic edema and predominates in the parietal and occipital regions, accompanied by clinical neurological alterations. Sever hypertension is a risk factor that exceeds the limits of brain autoregulation, leading to breakthrough brain edema. In our knowledge this is the first case reported in literature, in which a similar vascular abnormality is linked to a PRES syndrome.