Griškaitė Patricija, Kvaščevičienė Eleonora, Sakalauskienė Gabija Laubner
Vilnius University, Vilnius, Lithuania.
Republican Vilnius University Hospital, Vilnius, Lithuania.
Acta Med Litu. 2025;32(1):173-181. doi: 10.15388/Amed.2025.32.1.20. Epub 2025 Feb 18.
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition characterized by disrupted cerebral autoregulation, often associated with clinical features such as hypertension, encephalopathy, seizures, and visual disturbances. Although it primarily affects females aged 20-65, posterior reversible encephalopathy syndrome can present across diverse demographics. This case underscores the critical importance of identifying uncommon risk factors to facilitate early diagnosis and optimal management.
A 37-year-old male with stage 3 chronic kidney disease secondary to hereditary nephropathy and a history of cocaine and alcohol misuse presented to the emergency department with recurrent seizures, hypertension, hyperthermia and altered consciousness. Imaging demonstrated cortical-subcortical hypodensities on CT and parieto-occipital FLAIR hyperintensities on MRI, consistent with the diagnosis of PRES. A diagnosis of PRES was confirmed based on the patient's history, neurological evaluation, and characteristic radiological findings.
Raising awareness of PRES and its less recognized but increasingly relevant risk factors, such as stimulant drug use - particularly cocaine - remains a critical aspect of improving diagnostic accuracy and management. Although PRES is typically reversible, delayed diagnosis and treatment may lead to permanent neurological complications, including cerebral infarction and hemorrhage.
后部可逆性脑病综合征（PRES）是一种罕见的神经系统疾病，其特征是脑自动调节功能紊乱，常伴有高血压、脑病、癫痫发作和视觉障碍等临床特征。尽管它主要影响20至65岁的女性，但后部可逆性脑病综合征可在不同人群中出现。该病例强调了识别罕见危险因素以促进早期诊断和优化管理的至关重要性。
一名37岁男性，患有遗传性肾病继发的3期慢性肾病，有可卡因和酒精滥用史，因反复癫痫发作、高血压、高热和意识改变就诊于急诊科。影像学检查显示CT上皮质-皮质下低密度影，MRI上顶枕叶FLAIR高信号，符合PRES的诊断。根据患者病史、神经学评估和特征性影像学表现确诊为PRES。
提高对PRES及其较少被认识但日益相关的危险因素（如使用兴奋剂药物——尤其是可卡因）的认识，仍然是提高诊断准确性和管理水平的关键方面。尽管PRES通常是可逆的，但延迟诊断和治疗可能导致永久性神经并发症，包括脑梗死和出血。
