SHM Converge Scientific Abstract ePoster Gallery-Unable to Express Due to Pres (Posterior Reversible Encephalopathy Syndrome)

Pdf Summary

This case describes a 77-year-old woman with metastatic renal cell carcinoma who developed acute aphasia, headache, nausea, and vomiting shortly after starting tivozanib. She also had several weeks of milder headaches and confusion after beginning the medication. On presentation, her blood pressure was elevated but not severely so, and her neurologic exam showed mixed expressive-conductive aphasia with word-finding difficulty, but no motor, sensory, or cranial nerve deficits.<br /><br />Because she arrived as a stroke code, CT head and CTA head/neck were performed and showed no hemorrhage or large vessel occlusion. MRI brain instead revealed multifocal posterior cerebral and cerebellar white matter changes with a miliary enhancement pattern, consistent with posterior reversible encephalopathy syndrome (PRES). The diagnosis was supported by her recent tivozanib use, history of hypertension, clinical symptoms, and rapid improvement.<br /><br />She was admitted for blood pressure monitoring and symptom control, but her blood pressure remained stable without medication. Tivozanib was discontinued. Her headache and aphasia improved dramatically to near baseline, and follow-up MRI 18 days later showed near-complete resolution of the prior abnormalities.<br /><br />The report emphasizes that PRES can mimic stroke and may present with focal deficits such as aphasia, especially when lesions involve the dominant hemisphere. While typical PRES is associated with severe hypertension, this case shows that PRES can occur without markedly elevated blood pressure. Key management includes recognizing the syndrome, controlling blood pressure, treating symptoms, and stopping the offending agent when applicable.

Asset Subtitle

Vineet Gupta

Meta Tag

Author List Andrew Valenciano, David Hibbert, Vineet Gupta

Category Clinical Vignettes

Concept Posterior Reversible Encephalopathy Syndrome

Concept Stroke

Concept Blood Pressure Control

Concept Risk Factor

Concept Imaging Finding

Distinguished Non-Finalist

Presenter Organization University of California, San Diego (UCSD)

Presenting Author Vineet Gupta

Track Adult

Keywords

posterior reversible encephalopathy syndrome

PRES

tivozanib

renal cell carcinoma

aphasia

stroke mimic

MRI brain

hypertension

white matter changes

drug-induced neurotoxicity

Posterior Reversible Encephalopathy Syndrome

Stroke

Blood Pressure Control

Risk Factor

Imaging Finding