A Rare Presentation of Posterior Reversible Encephalopathy Syndrome in a Previously Healthy Young Male: A Case Report

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by vasogenic cerebral edema, typically associated with hypertension, renal failure, or immunosuppressive therapy. We present a unique case of a 19-year-old, previously healthy male who developed PRES in the setting of an acute hypertensive crisis, with an atypical presentation including severe cerebellar edema and obstructive hydrocephalus, necessitating emergent neurosurgical intervention. Unlike typical cases, this patient had no prior history of hypertension or known risk factors, highlighting the importance of considering secondary causes of hypertension in young individuals. His hospital course was further complicated by visual impairment due to hypertensive retinopathy and pneumonia, requiring bilevel positive airway pressure (BiPAP) support. This case expands the spectrum of PRES presentations, emphasizing that acute, severe hypertension alone can precipitate life-threatening complications. Early recognition, aggressive blood pressure management, and thorough evaluation for underlying etiologies are crucial in optimizing patient outcomes.

Keywords: acute hydrocephalus; cerebellar edema; hypertensive crisis; posterior reversible encephalopathy syndrome (pres); reversible posterior leukoencephalopathy syndrome (rpls); vasogenic brain edema.