Posterior Reversible Encephalopathy Syndrome Associated With Coarctation of the Aorta

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by acute encephalopathy due to different medical conditions. This syndrome may present with a wide spectrum of neurological symptoms including headache, disorders of consciousness, visual changes, seizures, and focal neurological deficits, in addition to nonspecific symptoms such as nausea and vomiting. Neuroimaging findings of bilateral cortical and subcortical brain edema involving the parieto-occipital regions are a hallmark of the disease. We present a case report of an eight-year-old boy who complained of headache and vomiting for 20 days until the discovery of severely high blood pressure (BP). He developed altered mental status, hemiplegia, loss of visual field, and seizure, requiring transfer to the intensive care unit. Magnetic resonance imaging of the brain showed hyperintense signals in the bilateral cortical and subcortical parieto-occipital areas. The BP measure of the extremities recognized a hypertensive upper extremity and normotensive lower extremity, and an MRI angiography was consistent with coarctation of the aorta (CoA). The fundoscopic exam showed no abnormalities. The diagnosis was kept as PRES secondary to a hypertensive emergency. Later, stenting of the aorta was performed, improving overall symptoms leaving a sequel loss of peripheral vision.