Posterior Reversible Encephalopathy Syndrome in Ischaemic Stroke with Malignant Hypertension, Chronic Kidney Disease, And Septic : A Case Report

Abstract

Posterior Reversible Encephalopathy Syndrome (PRES) is a diagnosis based on neuroimaging with the finding of vasogenic edema, especially in the occipital and parietal lobes. Some of the risk factors include malignant hypertension, chronic kidney failure, organ transplantation, autoimmune, immunosuppressant drugs, chemotherapy, and sepsis. The PRES mechanism is due to disrupted autoregulation, especially in the posterior circulation which is associated with hypertension and hypoperfusion. This will cause damage to the blood-brain barrier and vasogenic edema. We report a woman, 70 years old, with the chief complaint of loss of consciousness accompanied by headache, vomiting, and restlessness. The patient has chronic hypertension and routine hemodialysis due to chronic kidney failure. On physical examination, the patient was somnolent, malignant hypertension, and hemiparesis sinistra. Imaging examination showed vasogenic edema of the right parietooccipital lobe. The patient was treated in the intensive care unit, given intravenous dexamethasone, antihypertension, antibiotic, and routine hemodialysis. Consciousness gradually improved.