Cocaine-Induced Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report Highlighting Neurological and Clinical Outcomes.

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition characterized by disrupted cerebral autoregulation, often associated with clinical features such as hypertension, encephalopathy, seizures, and visual disturbances. Although it primarily affects females aged 20-65, posterior reversible encephalopathy syndrome can present across diverse demographics. This case underscores the critical importance of identifying uncommon risk factors to facilitate early diagnosis and optimal management.

Clinical case: A 37-year-old male with stage 3 chronic kidney disease secondary to hereditary nephropathy and a history of cocaine and alcohol misuse presented to the emergency department with recurrent seizures, hypertension, hyperthermia and altered consciousness. Imaging demonstrated cortical-subcortical hypodensities on CT and parieto-occipital FLAIR hyperintensities on MRI, consistent with the diagnosis of PRES. A diagnosis of PRES was confirmed based on the patient's history, neurological evaluation, and characteristic radiological findings.

Conclusions: Raising awareness of PRES and its less recognized but increasingly relevant risk factors, such as stimulant drug use - particularly cocaine - remains a critical aspect of improving diagnostic accuracy and management. Although PRES is typically reversible, delayed diagnosis and treatment may lead to permanent neurological complications, including cerebral infarction and hemorrhage.