A case of posterior reversible encephalopathy syndrome associated with medullary infarction

Abstract

A 66-year-old man suddenly presented with dysphagia, dysarthria, right-sided ataxia, and marked hypertension. MRI showed acute ischemic stroke in the right medulla oblongata due to an occlusion of the right vertebral artery. Scattered edematous lesions were also present in the cerebral cortex and thalamus bilaterally, and subarachnoid hemorrhage was observed in the left cerebral convexity. The patient had a generalized seizure on day 2 of admission. Edematous lesions were completely improved over time by antihypertensive therapy. Clinical diagnosis of posterior reversible encephalopathy syndrome (PRES) was made. Rapid marked hypertension due to an impaired baroreceptor reflex and an excitatory reaction of sympathetic nervous system after medullary infarction including the solitary nucleus may be the underlying mechanism in the development of PRES.