Posterior Reversible Encephalopathy Syndrome (P.R.E.S.) -a case report
Introduction
Posterior reversible encephalopathy syndrome is a cliniconeuroradiological entity characterized by collection of symptoms by different aetiologies .The most important symptoms are confusion, headache, seizures, blindness or cortical visual disturbances and rarely, other focal neurological signs. There are many known causes such as hypertension, pre-eclampsia/eclampsia, tacrolimus or cyclosporin A neurotoxicity, uraemia and porphyria, but there are many other unknown causes too .
In this article we report a case of PRES who presented with headache,seizures and visual disturbances where the blood pressure was very high and the aetiology was acute glomerular…show more content… He had no fever, photophobia or behavioral disturbances. He was treated as having B/L mumps by GP one week back when he presented to him with fever and facial swelling and subsequently mother had noted a mild distension of abdomen as well. He gives a history of sore throat 2 weeks back and had no significant past medical illnesses.
CT brain was done at Base Hospital on day 2 of admission which was normal. Visual disturbances persisted after the admission. Examination revealed a mild periorbital oedema and a BP of 150/100 which was well above 99th centile for him .Visual assessment showed B/L visual acuity of 6/12 and fundoscopy and retina were normal. Rest of the neurological and other system examinations were normal. Basic Investigations revealed a UFR with 3-5 pus cells and moderately field full of red cells. ASOT was 200. CBC, CRP, ESR, S Calcium, Liver function tests and Renal function tests were normal. CSF full report, CSF culture and CSF and serum for mumps antibodies were negative. Blood and Urine cultures were…show more content… Press is characterized by variable associations of consciousness impairment ,seizure activity, headaches ,visual abnormalities and cerebral imaging abnormalities often symmetric and predominate in the posterior white matter. High mean blood pressure is often observed in this syndrome but its level is not correlated to the severity. PRES is typically reversible once the cause is removed. However failure to diagnose may lead to irreversible infarction and death[5]. Common clinical manifestations are seizure activity ;generalized/focal with secondary generalization, consciousness impairment; confusion, somnolence, lethargy encephalopathy or coma, headache, visual abnormalities ; blurred vision, visual neglect, homonymous hemianopia, visual hallucinations or cortical blindness. Acute Hypertension is frequently associated. PRES is a clinicoradiological entity where the combination of suggestive clinical manifestations and radiological criteria establishes the diagnosis. The clinical and radiological improvement that occurs following appropriate treatment is given also confirms the diagnosis in doubtful
