Posterior reversible encephalopathy syndrome in a woman with focal segmental glomerulosclerosis

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome characterized by reversible vasogenic edema in the posterior hemispheres. PRES is most often attributed to primary hypertension, pre-eclampsia, and neurotoxicity secondary to immunosuppressants such as cyclosporine. Renal disease is an infrequent cause of PRES with a majority of cases occurring in adults with complete renal failure or in pediatric cases with underlying renal parenchymal disease and concurrent immunosuppressive therapy. Typical symptoms include seizure, headache, altered mental status, and visual disturbances. PRES is rarely associated with cerebral hemorrhage, and even less so with subarachnoid bleeds. Herein we report on a 25-year-old female with focal segmental glomerulosclerosis who developed PRES. The patient's presentation was more severe as she presented with seizure, nephrotic syndrome, and subarachnoid hemorrhage. Computed tomography and magnetic resonance imaging with concurrent symptoms led us to the final diagnosis. The patient was treated with antihypertensives, diuretics, and corticosteroids and follow-up imaging revealed resolution of PRES. Our case illustrates that underlying kidney disease even without immunosuppressive agents should be added to the list of possible causes for PRES. Symptoms are reversible with treatment of underlying cause or offending agent.

Keywords: PRES; focal segmental glomerulosclerosis; posterior reversible encephalopathy syndrome; subarachnoid hemorrhage.

Figure 1

MRI of the brain on admission revealing (A) cortical hyperintensity in the posterior parieto-occipital lobe, which suggests the presence of PRES; (B) follow-up MRI 10 days after symptom onset showing resolution of PRES. Abbreviations: MRI, magnetic resonance imaging; PRES, posterior reversible encephalopathy syndrome.