Case of the Month #41 Posterior Reversible Encephalopathy Syndrome (PRES)

Published 20/07/2023

What are the next investigations should you consider?

  • Invasive blood pressure monitoring 

  • Fundoscopy 

  • Blood tests:  FBC, Renal function, Inflammatory markers, clotting screen 

  • Blood gas analysis 

  • Blood glucose 

  • Urine dip 

  • CT head scan, consider CT angiogram and venogram 

  • Lumbar Puncture including opening pressure 

  • EEG 

  • MRI [1] 

On day 1 in intensive care, there is worsening renal function with AKI stage 2. Her blood pressure is controlled to <180mmHg systolic with labetalol by infusion.  She has a CT brain scan and this is reported as normal.  She has a lumbar puncture with an opening pressure of 22 cmH20, clear and colourless CSF with 0 RBCs, normal WBCs and protein 70 mg/dL. 

On day 2 in intensive care, the patient undergoes an EEG.  This shows focal sharp-wave discharges.  An MRI bilateral occipital, parietal, frontal cortex and subcortical white matter T2/FLAIR hyperintensities.