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Título

Reversible Posterior Leukoencephalopathy Syndrome (PRES): Case report

RESUMO

Case presentation: A 37-year-old male patient was brought to our Neurologic Emergency Department with acute ataxic neuropathy, cortical blindness, vertigo, gaze palsy, skew deviation, paresthesia associated with tonic-clonic seizures and impaired consciousness. As a result of topographical manifestations, a neurovascular syndrome in the vertebrobasilar arterial territory was hypothesized, consequently undergoing an attempt at chemical reperfusion. However, after the resolution of the acute phase, the patient remained under amaurosis bilaterally, and an etiological evaluation was initiated by requesting MRI Neuroimaging and subsequently lumbar puncture (LP). Radiological findings include confluent areas of T2 hyper signal and posterior cortical lesions when assessed using the FLAIR modality. In addition to DWI sequence, we can distinguish vasogenic edema in the brainstem and cerebellum. Also, cortical laminar necrosis and the corpus callosum are observed, suggesting the diagnosis of Reversible Posterior Leukoencephalopathy Syndrome (PRES). Promptly recognized, we initiated an etiological investigation regarding possible associated comorbidities with severe blood pressure and biochemical management. After 02 weeks, the patient reported regaining visual capacity in low acuity, which he progressively recovered during hospitalization. Thenceforth, he remains at our service for adequate neurologic rehabilitation control.

Discussion: Reversible Posterior Leukoencephalopathy Syndrome (PRES) is a rare clinical and radiological entity characterized by acute posterior topographical symptoms and mostly reversible characteristics when prompt recognition and treatment occur. The pathophysiology remains unclear, associating endothelial cell dysfunction and dysautonomic changes like arteriolar constriction or dilatation, which may lead to a breakdown of the Blood-Brain Barrier (BBB). Also, as observed in MRI scans, intense vasoconstriction should evolve with local hypoperfusion, cytotoxic edema, and cerebral infarction. The prevention and treatment evolve control of arterial hypertension, reduction of immunosuppressive drugs, and electrolyte disturbances management.

Conclusion: This presentation describes a patient with PRES who fully recovered from his respective Focal Neurologic Deficits (FND), such as cortical blindness. Most cases in this syndrome result from case reports and case series, requiring multicenter trials to define a reliable conclusion.

Palavras Chave

PRES; Reversible