Pediatric PRES With Isolated Brainstem and Spinal Cord Involvement Secondary to a Paraganglioma

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic condition characterized by potentially reversible vasogenic edema, often triggered by acute blood pressure fluctuations and endothelial dysfunction. We report a case of a 14-year-old girl who presented with headache and blurred vision in a hypertensive crisis. Brain imaging showed abnormal T2 signal hyperintensity in the lower medulla and cervical cord, without cerebral involvement. Chest and abdominal imaging revealed a retroperitoneal mass that was later confirmed to be paraganglioma. Neuroimaging abnormalities resolved after antihypertensive treatment and subsequent tumor resection. Our case is unique, to our knowledge, in showing pediatric PRES isolated to the brainstem and spinal cord, without typical cerebral lesions, secondary to a paraganglioma. We emphasize the importance of recognizing atypical imaging features of PRES and using imaging to isolate the cause and confirm reversibility.