PRES and RCVS: Two Distinct Entities or a Spectrum of the Same Disease?

Area of Science:

• Neurology
• Neuroscience
• Vascular Neurology

Background:

• Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are distinct neurological conditions.
• Both conditions present with overlapping clinical and imaging features, necessitating a deeper understanding of their relationship.

Observation:

• A case is presented of a patient with coexisting PRES and RCVS, exhibiting neurological symptoms and characteristic imaging findings.
• The patient presented with visual disturbances and hemiparesis, with brain imaging revealing cytotoxic and vasogenic edema and vascular imaging suggesting reversible vasculopathy.

Findings:

• PRES is characterized by vasogenic edema, often in the parieto-occipital regions, associated with symptoms like encephalopathy and seizures.
• RCVS involves reversible vasoconstriction of cerebral arteries, typically presenting with thunderclap headache.
• The reported case demonstrated features of both PRES and RCVS, indicating their potential to co-occur.

Implications:

• The co-occurrence of PRES and RCVS suggests a shared pathophysiological pathway.
• This pathway likely involves reversible dysregulation of cerebral vasculature, endothelial dysfunction, and blood-brain barrier breakdown.
• Further research into this shared mechanism could lead to improved diagnostic and therapeutic strategies for these conditions.