Recurrent PRES in a Patient With Cyclic Vomiting Syndrome

Area of Science:

• Neurology
• Gastroenterology
• Pediatrics

Background:

• Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent nausea and vomiting, often with autonomic dysregulation and hypertension.
• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition associated with acute hypertension and vasogenic edema on neuroimaging.

Purpose of the Study:

• To describe a case of recurrent hypertensive PRES in an adolescent with a history of CVS.
• To explore the potential link between CVS-related autonomic dysfunction and PRES.
• To emphasize the importance of recognizing and managing hypertensive PRES in this patient population.

Main Methods:

• Case report of a 16-year-old female with CVS and chronic hypertension.
• Review of medical history, including prior PRES episode in 2012.
• Neuroimaging (MRI) to confirm PRES and assess vasogenic edema.
• Systematic exclusion of secondary causes of hypertension.

Main Results:

• The patient experienced MRI-confirmed PRES during a period of sustained postoperative hypertension.
• Neuroimaging showed vasogenic edema in the parieto-occipital lobes and cerebellar vermis.
• Secondary causes of hypertension were excluded, and PRES was attributed to the patient's hypertension, potentially influenced by CVS-related autonomic dysregulation.

Conclusions:

• Recurrent hypertensive PRES can occur in adolescents with CVS.
• Hypertension is the primary driver of PRES, but CVS-related autonomic dysregulation may be a contributing factor.
• Prompt antihypertensive therapy and seizure prophylaxis are crucial for managing PRES in such cases, alongside excluding other etiologies.