Atypical posterior reversible encephalopathy syndrome (PRES): is peritoneal dialysis a risk factor?

A patient with diabetes mellitus who had recently been started on peritoneal dialysis presented with headaches, confusion, falling episodes, and multiple white matter abnormalities affecting the frontal, temporal, parietal, and occipital lobes on MRI of the brain. He developed stupor and frequent seizures despite control of hypertension with intravenous nicardipine. Diagnosis of atypical PRES and institution of successful empiric therapy was based on electronic searches (Google and MEDLINE) facilitated by verbal communication between and among the specialists involved in his care.