Posterior Reversible Encephalopathy Syndrome (PRES) Associated With COVID-19 Infection—A Case Report and Review

Coronavirus disease 2019 (COVID-19) has caused a large number of systemic complications including a variety of neurological complications. Some of the neurological complications are not known. Posterior reversible encephalopathy syndrome (PRES) is a known acute neurotoxic syndrome causing a wide range of neurological symptoms. If remains untreated, it can potentially become a life-threatening condition. However, it is not a known neurological complication of COVID-19. We describe a presentation of PRES in a patient with positive COVID-19 and presented with altered mental status. A 78-year-old male with history of idiopathic epilepsy was initially admitted with respiratory illness with negative COVID-19 test. Later during his hospitalization, his respiratory condition got worse and his repeat COVID-19 test came back positive. He had continued encephalopathy and was found to have status epilepticus afterward. Magnetic Resonance Imaging brain showed extensive PRES-related changes. His blood pressure remained overall within control without significant fluctuations. No other apparent etiology was identified for PRES except for possible correlation with COVID-19. Clinicians should consider PRES early in their differential diagnoses in patients with severe COVID-19 with continued encephalopathy.

Posterior reversible encephalopathy syndrome (PRES) of the brainstem

A 71-year-old man had disordered consciousness whose Glasgow Coma Scale was E4V1M5. His blood pressure was high, but there was no abnormality in the cerebrospinal fluid examination. The MRI finding reveals a high-intensity area at the pons without the blood flow interruption. Thus, he has diagnosed with brainstem PRES

Complete Neurological Recovery In A 3 Year Old Presenting With Posterior Reversible Encephalopathy Syndrome Due To Idiopathic Hypertension – A Case Report

Posterior reversible encephalopathy syndrome is an acute neurological illness presenting with clinical symptoms and distinctive MRI findings. Symptoms include headaches, seizures, altered consciousness as well as visual impairment. PRES is always accompanied by peculiar radiological findings of edematous change affecting the rear cerebral area. It commonly occurs in settings where patients are undergoing hypertensive crisis, or there is the use of steroids, calcineurin inhibitors, in the nephritic state or end-stage renal disease. The management includes treating the underlying cause and symptomatic therapy. However, due to relatively fewer pediatric reports, its management isn’t specific and rather based on experience. Our patient is a 3-year-old male, who presented with hypertensive crisis and MRI findings confirmed it to be a case of PRES. He was managed with a combined regime of antihypertensive and steroids which lead to complete neurological recovery and resolution of PRES. There are a scarce number of case reports on the use of steroids for the treatment of vasogenic oedema in children.