Posterior Reversible Encephalopathy Syndrome With Spinal Cord Involvement: A Case Report and Literature Review

We report a rare presentation of posterior reversible encephalopathy syndrome with spinal cord involvement (PRES-SCI) in a 14-year-old girl presenting with severe symptomatic hypertension secondary to bilateral renal dysplasia and grade 4 hypertensive retinopathy causing near blindness in her right eye. Magnetic resonance imaging of the brain and spine showed patchy T2 hyperintensity in the basal ganglia, brainstem, and cerebellum and extensive longitudinal central gray and white matter T2 hyperintensity in the spinal cord from the cervical cord to the conus. Despite extensive neuroimaging changes, she had no neurological signs apart from a visual acuity of 3/95 (20/400 Snellen) of the right eye. The imaging changes completely resolved on follow-up neuroimaging with blood pressure control, although a visual acuity deficit persisted. This case report and review of the literature highlights the rare presentation of PRES-SCI in the pediatric population and emphasizes the need for early recognition and treatment to ensure good neurological outcome and to avoid misdiagnoses.