Unravelling the Overlap: Exploring the Duality of PRES and RCVS: A Case Series
Pranav Mehta1, Sankar Gorthi1, Ananya Talukdar2, Advait Teli2, Siddhartha Kakani2
1Bharati hospital, 2Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
Objective:
To question the relationship between Posterior Reversible Encephalopathy Syndrome (PRES) and Reversible Cerebral Vasoconstriction Syndrome (RCVS) and determine whether they are independent, overlapping entities or part of a continuum.
Background:

RCVS causes severe headaches and reversible artery narrowing, leading to stroke. PRES presents with headaches, seizures, and visual or mental disturbances due to vasogenic edema, due to hypertension. Both are typically reversible but can result in brain damage.


Design/Methods:
A case series of four patients with PRES leading to RCVS.
Results:

Case summaries: 


Case 1: A 30-year-old female presented with tonic-clonic movements, and uprolling of eye for 30 minutes. Blood-pressure was 160/100mmHg with a GCS of E2VtM2. Imaging showed FLAIR hyperintensities in the occipital lobes, microhemorrhages and hypoperfusion. 


Case 2: A 55-year-old male with a history of diabetes, chronic alcoholism and tobacco chewing presented with complaints of generalized headacheand left-sided weaknes. With a blood pressure of 210/100, GCS score of E4V5M6,and papilledema on fundic examination.MRI revealed right parieto-occipital hyperintensities. 


CASE 3: A 40-year-old pregnant female with severe preeclampsia, with sudden, painless loss of vision post-cesarean, introperatively patient had a drop in blood pressure upto 70/40mmhg. Hyperintensities were seen in bilateral fronto-parieto-occipital regions and left cerebellum on MRI.

CASE 4: A 48-year-old female with hypertension, tuberculosis, and chronic kidney disease on hemodialysis who developed restlessness, anasarca, and breathlessness before a sudden decline in consciousness, with blood pressure was 190/110mmHg and GCS score deteriorated to E1V1M3 showed hyperintensities in the bilateral fronto-parieto-occipital and cerebellar regions on imaging.


Conclusions:
We highlight the complexities of PRES and RCVS, as evidenced by the clinical presentations and imaging findings. There is a dire need to understand which cases of PRES lead to RCVS to refine diagnostic and therapeutic approaches.
10.1212/WNL.0000000000211213
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