Contrast-induced posterior reversible encephalopathy syndrome following diagnostic angiography of vertebral artery.

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by transient vasogenic edema, predominantly affecting the white matter in the posterior cerebral hemispheres. It presents with acute neurological symptoms such as headaches, visual disturbances, and seizures. The pathophysiology of PRES, including its overlap with contrast-induced encephalopathy and transient cortical blindness, remains unclear.

Case description: A 76-year-old woman with a basilar artery aneurysm underwent diagnostic angiography. During the procedure, she experienced a hypertensive spike following the injection of contrast medium. Four hours post-angiography, she developed disorientation and bilateral light perception, which progressed to complete blindness. Magnetic resonance imaging revealed bilateral occipital hemisphere edema, confirming a diagnosis of PRES. All neurological symptoms resolved within 48 h. Subsequently, she successfully underwent coil embolization of the aneurysm. With careful blood pressure management and a switch to a different type of contrast medium, PRES did not recur despite the use of a larger volume of contrast medium.

Conclusion: This case of contrast-induced PRES underscores the potential overlap in pathogenesis between PRES and contrast-induced encephalopathy. It emphasizes the need for careful blood pressure management and consideration of contrast medium type in patients undergoing angiography, especially those with a history of PRES. The successful management of this case provides valuable insights into the prevention and treatment of PRES in similar clinical scenarios.