Rare multi - regional involvement in posterior reversible encephalopathy syndrome with spinal cord involvement of a young hypertensive male: a case report

Posterior reversible encephalopathy syndrome (PRES) is an acute or subacute cerebral syndrome which primarily manifests as headache, encephalopathy, seizures, and visual disturbances in various combinations. PRES with spinal cord involvement (PRES-SCI) is extremely rare and considered to be a variant of PRES. We present a case of PRES-SCI where the patient primarily manifested with bilateral blurred vision. The brain and spinal cord MRI showed that the lesions simultaneously affected the supratentorial region, infratentorial region, and spinal cord, and malignant hypertension was identified as the underlying etiology. After 8 days of blood pressure control, a follow-up MRI revealed obvious disappearance of the imaging lesions and full resolution of the blurred vision. Timely blood pressure management in PRES-SCI, even with extensive cerebral and spinal cord involvement, can lead to rapid symptom resolution and significant lesion reduction on imaging.