2023 Volume 45 Issue 4 Pages 324-330
An 88-year-old woman was transported to our hospital two days prior because of unconsciousness and headache. She showed mild unconsciousness (Japan Coma Scale: 3) and hypertension (261/127 [172] mmHg), and head MRI revealed high-intensity area at the brain stem and bilateral posterior white matter. She was diagnosed with posterior reversible encephalopathy syndrome (PRES) and administered anti-hypertension therapy, which cured her unconsciousness on day 4. For treating renal failure, a diuretic drug was administered. On day 8, head MRI showed improvement of PRES; however, new cerebral infarction was also found at the bilateral hemisphere watershed area. We decreased the diuretic drug to increase the cerebral blood flow, and no new neurological deficits emerged. In cases of PRES induced by hypertension, the lowering of blood pressure is crucial, but the risk of hemodynamic infarction caused by too rapid lowering of blood pressure must be considered. We should explain the possibility of developing hemodynamic infarction to the elderly in advance.
