Posterior reversible encephalopathy syndrome with spinal cord involvement

Area of Science:

• Neurology
• Radiology
• Nephrology

Background:

• Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition characterized by headache, seizures, and visual disturbances.
• PRES typically involves the brain, but its involvement in the spinal cord is less understood.

Observation:

• This study identified 8 cases of PRES with spinal cord involvement (PRES-SCI).
• Patients presented with severe hypertension and characteristic spinal cord MRI findings, including T2 hyperintensity extending from the cervicomedullary junction.
• Most patients experienced a favorable outcome with antihypertensive treatment.

Findings:

• PRES-SCI is characterized by severe acute hypertension and extensive spinal cord T2 hyperintensity.
• Neurologic symptoms referable to spinal cord lesions were present in half of the patients.
• Hypertensive retinopathy and resolution of spinal lesions on follow-up imaging were common.

Implications:

• The findings suggest expanding the definition of PRES to include spinal cord involvement.
• Prompt cervical spine MRI is recommended for patients with PRES and concerning neurologic signs.
• Diagnosing PRES-SCI can prevent unnecessary investigations and treatments for conditions like myelitis.