Posterior Reversible Encephalopathy Syndrome in an Adult Male With Uncontrolled Blood Pressure and Cocaine Use: A Case Report

Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome that is diagnosed by neurologic symptoms and radiologic findings. PRES is predominantly caused by uncontrolled hypertension though it has been associated with illicit drug use, specifically cocaine use. We describe a case of a 68-year-old male who developed visual disturbances and gait abnormalities. Imaging was confirmed with head CT that showed hypoattenuation in the posterior aspects of the occipital lobes. The patient was managed with anti-hypertensive medication and blood pressure monitoring during his hospital course. Therefore, the patient's neurological symptoms resolved once the blood pressure was well-controlled. MRI of the brain was completed prior to discharge and confirmed resolution. Hypertension and cocaine use has been documented as causative agents of PRES. It is most likely due to the inability of the posterior circulation of the brain to auto-regulate with acute changes in blood pressure resulting in hypoperfusion and disruption of the blood-brain barrier with resultant vasogenic edema without infarction.