Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by neurological symptoms and radiological findings of symmetrical vasogenic edema. There have been various reports of this syndrome in a variety of clinical settings. We describe here a case of PRES from acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE). A 16-year-old male developed abdominal pain with nausea and vomiting following physical exercise at school (anaerobic exercise, in the form of 200-meter track racing), which lasted for 3 days from onset. He was admitted to our hospital with seizures and a disturbance of consciousness. Laboratory tests on admission revealed a serum creatinine level of 5.05 mg/dl and uric acid of 13.1 mg/dl, without any elevation of serum myoglobin and creatinine phosphokinase. The non-oliguric acute renal failure improved without any treatment other than proper volume load and diuretics. Renal computed tomography scan, performed several hours after contrast medium administration, revealed multiple wedge-shaped areas of contrast enhancement; therefore, the patient was diagnosed with ALPE. Brain CT showed no abnormal findings, although cranial MRI with T2-weighted and fluid attenuated inversion recovery (FLAIR) imaging revealed increased signal intensities in the subcortical white matter bilaterally. Since the apparent diffusion coefficient (ADC) map showed a vasogenic edema pattern, the patient was diagnosed as PRES. In diagnosing PRES, it may be essential to bear the possibility of PRES in mind. MRI provides a useful means of diagnosis.
