Atypical posterior reversible encephalopathy syndrome (PRES): is peritoneal dialysis a risk factor?

Area of Science:

• Nephrology
• Neurology
• Radiology

Background:

• Peritoneal dialysis is a common treatment for end-stage renal disease.
• Diabetes mellitus is a common comorbidity in patients requiring dialysis.
• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition that can occur in patients with various medical conditions.

Observation:

• A patient with diabetes mellitus recently initiated on peritoneal dialysis presented with neurological symptoms including headaches, confusion, and falling episodes.
• Brain MRI revealed widespread white matter abnormalities in multiple lobes.
• The patient's condition progressed to stupor and seizures despite hypertension management.

Findings:

• The clinical presentation and MRI findings suggested an atypical Posterior Reversible Encephalopathy Syndrome (PRES).
• Diagnosis was aided by electronic literature searches (Google, MEDLINE) and interdisciplinary communication.
• Empiric therapy was instituted, leading to a successful clinical outcome.

Implications:

• This case highlights the importance of considering atypical PRES in dialysis patients with neurological symptoms.
• Effective management relies on prompt diagnosis and appropriate empiric treatment.
• Interdisciplinary collaboration and access to medical literature are crucial for managing complex cases.