Recurrent posterior reversible encephalopathy syndrome in end-stage renal disease: A clinical case rReport

Abstract

Posterior reversible encephalopathy syndrome is a clinical-radiological disorder characterized by seizures, headaches, and visual disturbances, typically involving vasogenic edema on neuroimaging. This report details a 21-year-old female with end-stage renal disease and hypertension who experienced recurrent PRES. Her initial episode presented with generalized seizures and drowsiness. One year later, following a renal transplant and treatment with pulse methylprednisolone for rejection, she experienced a second episode manifesting as vision loss and recurrent seizures. MRI confirmed recurrent PRES, showing patchy high T2 signals across multiple brain regions, including the cerebellar hemispheres and pons. Management focused on blood pressure control and hemodialysis, resulting in significant clinical improvement. Patients with chronic renal illness are particularly susceptible to PRES due to hypertension and immunosuppression. Early recognition and prompt management of blood pressure are vital to preventing permanent neurological damage or chronic epilepsy in this population.

Keywords: Posterior reversible encephalopathy syndrome; End-stage renal disease; Hypertension; Renal transplant; Seizures; Magnetic resonance imaging.