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Neurological Rehabilitation

Posterior Reversible Encephalopathy Syndrome (PRES) after Infection and Acute Kidney Injury: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 7

    Poster Presenter(s)

  • Charlotte DeRose, DO

    Resident Physician
    University of Alabama Medical Center PM&R Program
    Birmingham, Alabama

    • Primary Author(s)

  • Casey Pierce, MD

    Resident Physician
    University of Alabama Medical Center PM&R Program
    Birmingham, Alabama

    • Co-Author(s)

  • RS

    Radhika Sharma, MD

    Assistant Professor
    University of Alabama at Birmingham
    Birmingham, Alabama

Disclosure(s):
Charlotte DeRose, DO: No financial relationships to disclose
Case Diagnosis: Acute kidney injury and infection lead to PRES in a young healthy adult with Incomplete tetraplegia

Case Description or Program Description: The patient presented with uncontrolled pain and spasticity due to his incomplete tetraplegia. He was titrated up over the course of 3 weeks to baclofen 10 mg three times daily (TID) and pregabalin 200 mg TID. His rehabilitation course was complicated by fevers, workup including imaging with IV contrast on day 7 and vancomycin/zosyn on day 8 of his rehabilitation stay. On day 10 he developed somnolence and urinary retention. Workup for altered mental status (AMS) revealed acute kidney injury (AKI), with creatinine rising from 0.4 to 4.3 mg/dL within 48 hours. His AMS worsened, prompting discontinuation of baclofen and pregabalin. Due to continued neurological decline and worsening renal function, he was transferred to the ICU, where he developed new-onset seizures. Brain MRI showed bilateral occipital and temporal FLAIR hyperintensities, consistent with posterior reversible encephalopathy syndrome (PRES).

Setting: Tertiary rehabilitation hospital

Assessment/Results: The patient developed AKI which was attributed to antibiotic use and contrast exposure. His clinical case progressed with worsening encephalopathy and seizures that imaging revealed to be due to PRES, attributed to adverse medication effects. At discharge, he required four antiepileptic medications for seizure control.

Discussion (relevance): Although an unusual progression, this case highlights AMS as an early sign of drug accumulation, warranting prompt recognition and intervention to prevent syndromes such as PRES from occuring.

Conclusions: Clinicians should maintain a high index of suspicion and a low threshold for screening for PRES in patients with new-onset AMS/seizures, even in young, healthy individuals. Additionally, toxicity from neuromodulating medications such as baclofen and pregabalin should be considered as possible precipitators of PRES.