Posterior Reversible Encephalopathy Syndrome Induced Demyelination (P3-2.011).
Publication/Presentation Date
4-8-2025
Abstract
OBJECTIVE: N/A.
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) typically manifests as vasogenic edema in the subcortical white matter, predominantly in the posterior cerebral hemispheres. These changes are generally reversible once the underlying cause is addressed. We present a case of PRES resulting in demyelination, as confirmed by subsequent tissue examination.
DESIGN/METHODS: A 68-year-old right-handed female with a history of hypertension, renal mass, and coronary artery disease presented with altered mental status. The patient reported feeling unwell, and the next day developed nonsensical speech, vision loss, and headaches. Upon arrival at the emergency department, her systolic blood pressure was recorded in the 240-250 range. An CT of the head showed no acute hemorrhage or infarct but revealed hypoattenuation in the bilateral occipital lobes, suggestive of PRES. A CTA of the head and neck revealed stable but severe stenosis of the right carotid bifurcation and moderate stenosis of the left carotid bifurcation. No large vessel occlusion was noted. A follow-up MRI of the brain showed FLAIR signal hyperintensities in the posterior parietal and occipital lobes, without hemorrhage or infarction. The patient was started on Keppra 500 mg twice daily and initiated on nicardipine. Over the next few days, she became more oriented and reported improved vision. She admitted to noncompliance with her blood pressure medications, though no other clear risk factors for PRES were identified. The patient was readmitted two weeks later for sepsis and passed away shortly after. Brain examination, as part of a requested autopsy, revealed several areas of demyelination that were not observed on prior MRI imaging.
RESULTS: N/a.
CONCLUSIONS: PRES typically results in permanent changes only when associated with secondary cerebral infarcts or hemorrhage. This case highlights possible irreversible demyelination, a finding not commonly reported in the literature, suggesting the need for further research into the long-term sequelae of PRES.
Volume
104
Issue
7_Supplement_1
First Page
4937
Last Page
4937
ISSN
1526-632X
Published In/Presented At
Singh, S., Chu, I., & Johnson, M. W. (2025). Posterior Reversible Encephalopathy Syndrome Induced Demyelination (P3-2.011). Neurology, 104(7_Supplement_1), 4937. https://doi.org/10.1212/WNL.0000000000212024
Disciplines
Medicine and Health Sciences
PubMedID
40193868
Department(s)
Department of Medicine, Fellows and Residents
Document Type
Article