[Posterior Reversible Encephalopathy Syndrome in a Patient with Chronic Kidney Disease on Hemodialysis and Refractory...

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by an acute or subacute neurological onset, typically reversible within a few days following the removal or control of the underlying triggering factor. Diagnosis is based on clinical presentation and imaging findings, particularly brain magnetic resonance imaging (MRI), which in most cases reveals bilateral and symmetrical areas of vasogenic edema, predominantly involving the parieto-occipital regions. PRES is frequently associated with predisposing conditions such as severe arterial hypertension, chronic kidney disease, autoimmune disorders, solid-organ transplantation, and treatment with immunosuppressive or cytotoxic agents. We describe the case of a patient with chronic kidney disease undergoing thrice-weekly hemodialysis who was admitted for acute alteration of consciousness and seizures associated with severe arterial hypertension. Brain MRI demonstrated areas of vasogenic edema consistent with PRES. Within a few days of presentation, adequate control of the severe hypertensive state led to a progressive resolution of the neurological symptoms, accompanied by a marked improvement in the radiological abnormalities, as confirmed by follow-up MRI.