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Open Access Highly Accessed Case report

Posterior reversible encephalopathy syndrome in an adult patient undergoing peritoneal dialysis: a case report and literature review

Brett R Graham1* and George B Pylypchuk2

Author Affiliations

1 Department of Medicine, Division of Neurology, University of Saskatchewan, Room 3544 RUH, 103 Hospital Drive, Saskatoon, SK, Canada

2 Department of Medicine, Division of Nephrology, University of Saskatchewan, Room 3544 RUH, 103 Hospital Drive, Saskatoon, SK, Canada

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BMC Nephrology 2014, 15:10  doi:10.1186/1471-2369-15-10

Published: 13 January 2014

Abstract

Background

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized clinically by headache, altered mental status, seizures, visual disturbances, and other focal neurological signs, and radiographically by reversible changes on imaging. A variety of different etiologies have been reported, but the underlying mechanism is thought to be failed cerebral autoregulation. To the best of our knowledge, we report the third known case of PRES in an adult receiving intermittent peritoneal dialysis (PD).

Case presentation

A 23-year-old male receiving PD was brought to hospital after experiencing a generalized seizure. On presentation he was confused and hypertensive. An MRI brain was obtained and showed multiple regions of cortical and subcortical increased T2 signal, predominantly involving the posterior and paramedian parietal and occipital lobes with relative symmetry, reported as being consistent with PRES. A repeat MRI brain obtained three months later showed resolution of the previous findings.

Conclusion

Due to having a large number of endothelium-disrupting risk factors, including hypertension, uremia, and medications known to disrupt the cerebrovascular endothelium, we suggest that those with end-stage renal disease (ESRD) receiving PD are at high risk of developing PRES. Furthermore, we surmise that PRES is likely more prevalent in the ESRD population but is under recognized. Physicians treating those with ESRD must have a high index of suspicion of PRES in patients presenting with neurological disturbances to assure timely diagnosis and treatment.

Keywords:
Peritoneal dialysis; Posterior reversible encephalopathy syndrome; End-stage renal disease; Hypertension