A Complicated Case of Posterior Reversible Encephalopathy Syndrome (PRES) Secondary to Severe Hypercalcemia

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Abstract Background:PRES is a rare but severe condition with highly variable neurologic manifestations ranging from headaches to seizures, coma and radiologic findings of focal vasogenic edema1. It is commonly caused by hypertension, chronic renal failure, preeclampsia / eclampsia and immunosuppressants. We are reporting a rare presentation of PRES caused by severe hypercalcemia. Clinical Case: A 29- year old female presented with frontal headaches, visual disturbance, emesis and confusion. Her medical history was relevant for hyperthyroidism treated with partial thyroidectomy (on methimazole) and complicated by iatrogenic hypoparathyroidism. The resulting hypocalcemia was managed with calcitriol and calcium supplementation. On presentation, the patient was awake but disoriented. Physical examination was remarkable for right-sided hemianopsia. Admission blood pressure (BP) was 192/127 suggestive of hypertensive emergency. Initial laboratory tests revealed severe hypercalcemia (calcium: 18.7 mg/dL, ionized: 2.1 mmol/L), acute kidney injury (creatinine of 2.5 mg/dL, (baseline =