Posterior reversible encephalopathy syndrome triggerred by alcohol withdrawal

Abstract

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by headache, altered mental status, epileptic seizures, visual disturbances and typically transient changes in posterior cerebral circulation areas. This article presents a case report of a patient with alcohol withdrawal accompanied by PRES. Case presentation: A 53-year-old male patient was presented to the Emergency Department with visual hallucinations and meaningless speech. History from his relatives revealed that he consumed alcohol for about 35 years with the last consumption 3 days ago. Neurological examination revealed limited cooperation and disorientation to person, place and time. This speech was incoherent and no localizing sign was observed. Cranial magnetic resonance imaging (MRI) revealed bilateral hyperintense areas in medial occipital cortices and in the subcortical white matter extending partly into the parietal region. Treatment for alcohol withdrawal was started. Signs and symptoms regressed on the 7th day of the treatment as well as the lesions on the MRI. Discussion: The clinical presentation, characteristic MRI features together with the reversible nature of the syndrome suggest the diagnosis of PRES. The precise pathophysiological mechanism of PRES still remains unclear. Hypertension, clinical conditions associated with impaired cerebral autoregulation as well as alcohol use which increases the levels of reactive oxygen species and nitric oxide, may lead to the disruption of endothelial cells and blood-brain barrier breakdown. We suggest that chronic alcoholism and alcohol withdrawal might have caused endothelial dysfunction leading to PRES in our patient.