An Atypical Presentation of Posterior Reversible Encephalopathy Syndrome (P4.016)

Objective: We describe a rare presentation of posterior reversible encephalopathy syndrome (PRES) with MRI (magnetic resonance imaging) signal abnormalities restricted to the brainstem and cerebellum. Background: PRES can present with non-specific neurological symptoms such as headaches, seizures, altered mental status, or visual disturbances and is postulated to be secondary to acute elevation of blood pressure (BP) above the upper limit of cerebral blood flow autoregulation. It is typically seen in association with the use of immunosuppressive agents, sepsis, or in the setting of acute or chronic kidney disease (CKD). Brain MRIs typically show parieto-occipital lobe involvement, however, other regions of the brain can be affected. Design/Methods: Case report and literature review. Results: A 36-year-old man with a PMH of diabetes and CKD presented with headaches, nausea, vomiting, and slurred speech. Neurological exam was remarkable for poor orientation, mild extremity weakness, and upper extremity cerebellar findings. Brain MRI showed diffuse T2 and FLAIR (fluid attenuated inversion recovery) abnormalities along with small foci of restricted diffusion involving the brainstem and cerebellum. BP was persistently elevated to u003e 200s systolic and u003e 110s diastolic. The patient was aggressively treated to a target BP goal of Conclusions: This is a unique case of PRES presenting with imaging abnormalities restricted to the brainstem and cerebellum. The patient’s clinical and radiological findings, although atypical, and subsequent improvement after aggressive treatment of his BP are consistent with rare case reports in the PRES literature. Such presentations are important to recognize because prompt management of elevated BP can help reverse this potentially debilitating disease entity. Disclosure: Dr. Martinez has nothing to disclose. Dr. Jillella has nothing to disclose. Dr. Donaldson has nothing to disclose.