IgA nephropathy with posterior reversible encephalopathy with spinal cord involvement in a young male: A case report

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological phenomenon commonly associated with kidney diseases, especially chronic kidney disease. A consequence of endothelial dysfunction, PRES is usually associated with uncontrolled blood pressures and can rarely have atypical radiological findings involving the brain stem and spinal cord, called posterior reversible encephalopathy with spinal cord involvement (PRES-SCI). These atypical features may be confused with other etiologies causing a delay in diagnosis and management. We describe a young male patient who presented with neurological symptoms suggestive of PRES; however, the atypical radiological findings along with concomitant rapidly progressive glomerulonephritis led to a diagnostic dilemma. Repeat neuro-imaging after appropriate blood pressure control showed disappearance of the lesions confirming the diagnosis of PRES-SCI, and kidney biopsy showed advanced IgA nephropathy. Knowledge of atypical features of PRES is crucial amongst nephrologists as it is a common association with kidney disease and prompt identification and management avoid irreversible sequelae and unnecessary investigations.

Chronic Glomerulonephritis and Malignant Hypertension With PRES (Posterior Reversible Encephalopathy Syndrome) Presenting As Status Epilepticus: A Case Report

“…Poor sympathetic innervation in the posterior circulation predisposes predilection for brain oedema in this region. These unusual characteristics could lead to a delay in diagnosis and treatment if they are mistaken for other etiologies [ 2 ].…”

“…Multiple neurological symptoms may appear or they may manifest alone, and they may change over the course of the acute stage of the illness. It typically manifests as a combination of nausea, one or multiple episodes of seizures, decreased mental function, headaches, and vision loss, but it can also include additional localised abnormalities like weakness, sensory disturbances, or speech disturbances [ 2 ].…”

“…Patients who are treated for nephrotic syndrome with extended steroid therapy or calcineurin inhibitor medication are at risk of developing PRES [ 1 ]. As a result of the low index of suspicion, early diagnosis and treatment of the syndrome are essential for the resolution of the symptoms and radiological features as well as to prevent complications like long-term neurological deficit [ 2 ].…”