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Posterior reversible encephalopathy syndrome with isolated infratentorial involvement: A case report

Amjad Samara1, Brent Berry2, Malik Ghannam2

  • 1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.

Radiology Case Reports
|March 20, 2019
PubMed

Insights

Posterior reversible encephalopathy syndrome (PRES) can affect the brainstem, cerebellum, and spinal cord, not just the typical brain regions. This rare variant highlights the diverse neurological manifestations of PRES, even in hypertensive emergencies.

Area of Science:

  • Neurology
  • Radiology
  • Nephrology

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is characterized by neurological symptoms and specific MRI findings, typically involving vasogenic edema in the parieto-occipital white matter.
  • Spinal cord involvement in PRES is uncommon and often overlooked.
  • Variant PRES with isolated infratentorial structural involvement is increasingly recognized.

Observation:

  • This case report details a patient experiencing a hypertensive emergency.
  • Radiological imaging revealed features consistent with PRES.
  • The PRES manifestation was notably isolated to the brainstem, cerebellum, and spinal cord.

Findings:

  • The patient presented with a hypertensive emergency.
  • Radiological findings confirmed PRES.
  • PRES exclusively affected the infratentorial structures (brainstem, cerebellum) and the spinal cord, deviating from the classical parieto-occipital presentation.

Implications:

  • This case expands the understanding of PRES's spectrum, particularly variant forms.
  • It underscores the importance of considering PRES in hypertensive emergencies, even with atypical imaging findings.
  • Recognizing isolated infratentorial and spinal cord involvement is crucial for timely diagnosis and management of PRES.
Keywords:
Hypertensive emergencyInfratentorial structuresPosterior reversible encephalopathy syndromeSpinal cord involvement

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