Association of Posterior Reversible Encephalopathy Syndrome with Renal Failure

Abstract

Background: Posterior reversible encephalopathy syndrome is a clinico-radiological entity that is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea, vomiting and focal neurological signs. No large data exists on the association of posterior reversible encephalopathy syndrome with renal failure. Materials and Methods: This case series of five patients was collected to examine the association of two conditions and evaluate outcome. All these patients were enrolled in a tertiary care hospital over a period of two years. No informed consent was sought because the study was merely observational and did not demand deviations from standard. Results: Four patients presented with acute renal failure and one patient had established End-Stage Renal Disease. All the patients had hypertension at presentation besides other risk factors. All the patients had Magnetic Resonance Imaging documented posterior reversible encephalopathy syndrome. Despite intensive management, two patients did not show any improvement of blood pressure control and died. This observation raises the possibility that renal failure increases mortality in patients with posterior reversible encephalopathy syndrome. However, our series is limited by small number of enrollees and hence no definite conclusions can be drawn from this observation. Conclusion: Posterior reversible encephalopathy syndrome should be considered in all those patients who have renal failure and associated neurological abnormalities. The association needs to be taken urgently and seriously.