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Posterior Reversible Encephalopathy Syndrome With Spinal Cord Involvement
Zachery Rohm1, Narender Annapureddy2, Kevin Byram2
1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN.
The Neurologist
|July 31, 2025
Summary
Posterior reversible encephalopathy syndrome with spinal cord involvement (PRES-SCI) is a rare condition. Early recognition in hypertensive patients with spinal cord lesions is crucial for appropriate management.
Area of Science:
- Neurology
- Radiology
- Nephrology
Background:
- Posterior reversible encephalopathy syndrome (PRES) involves cerebrovascular autoregulation failure, leading to fluid extravasation in the brain.
- PRES with spinal cord involvement (PRES-SCI) is a rare manifestation of this condition.
Purpose of the Study:
- To describe a case of PRES-SCI in a patient with lupus nephritis.
- To highlight the diagnostic considerations and clinical presentation of PRES-SCI.
Main Methods:
- Case report of a 34-year-old woman with lupus nephritis presenting with PRES symptoms.
- Brain and spine MRI were utilized to identify characteristic lesions.
- Exclusion of alternative myelitis causes through antibody testing.
Main Results:
- The patient presented with altered mental status, blurred vision, seizures, and severe hypertension.
- Brain MRI showed PRES-compatible lesions; spine MRI revealed extensive, nonenhancing spinal cord lesions.
- Symptoms resolved with blood pressure control, and alternative myelitis causes were ruled out.
Conclusions:
- PRES-SCI is an under-recognized variant of PRES, often associated with severe hypertension.
- Consider PRES-SCI in patients with acute hypertension and characteristic spinal cord MRI findings.
- Prompt diagnosis of PRES-SCI can prevent unnecessary investigations and treatments for myelitis.
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