Introduction: Posterior Reversible
Leukoencephalopathy Syndrome (PRES) is caused by
ischaemia commonly affecting the posterior cerebral
vasculature. It presents with sudden decreased vision,
headaches, nausea, vomiting, seizures, and altered
mental status.
Case presentation: A 19-year-old male presented to
the ophthalmic emergency complaining of sudden
bilateral loss of vision, which was down to light
perception He reported headaches, nausea, and
drowsiness since the previous day. He was a known case
of hypertension secondary to IgA nephropathy.
Magnetic resonance imaging (MRI) with STIR and
FLAIR sequences showed foci of hyperintensity within
the occipital lobes bilaterally. This confirmed the
suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include
sudden increase in blood pressure, eclampsia, porphyria,
renal disease, and Cushing syndrome. These lead to
blood-brain barrier injury either by hyper- or hypoperfusion,
endothelial dysfunction, changes in blood
vessel morphology, hypocapnea, or immune system
activation. Histopathological changes in PRES include
activated astrocytes, scattered macrophages and
lymphocytes, often in the absence of inflammation or
neuronal damage.
Conclusion: PRES is usually a reversible neuroophthalmological
condition, however prompt
recognition and appropriate management is important to
prevent permanent brain injury or even death.peer-reviewe
