Abstract Details

Title Posterior Reversible Encephalopathy Syndrome with Spinal Cord Involvement (PRES-SCI) - a Case Report and Literature Review

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 180

Objective We describe a unique case of PRES-SCI occurring after an extensive burn injury. Additionally, we complete a literature review on the existing cases of PRES-SCI.

Background PRES-SCI has been described in the literature as early as 2008 but remains poorly understood. This variant of PRES involves confluent T2 hyperintensities in the spinal cord and is secondary to decreased sympathetic innervation in the posterior circulation. The spinal cord has decreased ability to regulate fluctuations in blood pressure, resulting in radiographic and sometimes clinical changes. Our case adds to the limited body of literature, and is the first case occurring secondary to hypertension in the setting of burns.

Design/Methods We described a case of PRES-SCI. We identified studies using a PUBMED search with the following terms: “PRES-SCI”, “posterior reversible encephalopathy syndrome with spinal cord involvement”, and “spinal PRES”.

Results

A 20-year-old female with burns (41% surface area) presented two months later with blurry vision, neurogenic bladder, weakness and new hypertension. Examination revealed bilateral cotton wool spots and macular edema. MRI showed non-enhancing, edematous lesions from the brainstem to the conus medullaris. Differential included demyelinating disease, acute disseminated encephalomyelitis and her final diagnosis PRES-SCI. Hydrocarbons inhalation causing myelin injury was unlikely 2 months post-burns. She received intravenous nicardipine and immunosuppression. 3 months later, her weakness and lesions resolved.

A total of 31 cases (mean age 20 years old) were reviewed from 2008-2021. All 32 patients, including our case, had elevated blood pressure (>140/80) and T2 hyperintense lesions spanning the brainstem to at least 4 segments of the spinal cord with unrevealing work up.

Conclusions Recognizing the features of PRES-SCI with hypertension, retinopathy and extensive spinal lesions can prevent immunotherapy. Hypertension is a long-term sequela of burns. PRES-SCI is likely under diagnosed due to patients with clinical radiologic dissociation and a lack of spinal imaging.

Authors/Disclosures
Mathura Ravishankar, MD (INOVA) PRESENTER	Dr. Ravishankar has nothing to disclose.
Alexandra Urban, MD, FAAN (University of Pittsburgh School of Medicine)	Dr. Urban has received personal compensation in the range of $0-$499 for serving as a Consultant for Neuropace. Dr. Urban has received personal compensation in the range of $0-$499 for serving as a Consultant for LivaNova.

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