A Case Of PRES Secondary To Renal Artery Stenosis Induced Hypertension

Posterior reversible encephalopathy syndrome (PRES) is a condition that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure with resultant hyperperfusion and vasogenicoedema, in the parieto-occipital regions. This presentation is to emphasize that renal artery stenosis, a cause of hypertension in young individuals may present as PRES. A 15 year old girl presented with head ache, giddiness and an episode of loss of consciousness for six minutes. On examination all vital parameters were normal except high blood pressure. CT Brain, MRI Brain, ultrasound abdomen and CECT abdomen was done. CT Brain showed mild diffuse cerebral edema with vasogenic edema in the bilateral parietal-occipital lobes. MRI Brain showed gyral and sub-cortical T2 hyperintense signal change in bilateral posterior parietal and left occipital lobes. Gyriform T2 hyperintense signal in parasagittal region in left superior frontal region with no significant restricted diffusion. USG abdomen showed contracted right kidney. Renal Doppler showed features of renal artery stenosis. CECT Abdomen showed Focal short segment high grade stenosis in juxtahilar portion of right renal artery. Diagnosis of PRES secondary to renal artery stenosis induced hypertension was made. Patient refused any surgical interventions. She was started on oral anti-hypertensive. Patient responded well to medications. Here we emphasize that Renal artery stenosis can be a cause in young patients with hypertension. While evaluating hypertensive patients with neurological symptoms like giddiness and loss of consciousness, Posterior reversible encephalopathy syndrome should be considered as a differential.