Internal medicine

Radiology

Pediatrics

Blood pressure

Magnetic resonance imaging

Intensive care medicine

Mechanical ventilation

Intensive care unit

Lethargy

Posterior reversible encephalopathy syndrome

Encephalopathy

Hypertensive encephalopathy

Intensive care

Anesthesia

Medicine

Journal of the Neurological Sciences

ObjectiveTo report four patients with coronavirus disease 2019 (COVID-19) who developed posterior reversible encephalopathy syndrome (PRES).MethodsPatient data was abstracted from medical records at Weill Cornell Medical Center.ResultsFour patients with SARS-CoV-2 infection and PRES were identified. The patients' ages ranged from 64 to 74 years, and two were women. All four patients were admitted to the hospital with acute respiratory distress syndrome requiring intensive care unit admission and mechanical ventilation. PRES was diagnosed after persistent confusion, lethargy, new focal neurological deficits, or seizures were noted, with evidence of seizures on electroencephalogram for two of the patients. Imaging confirmed the presence of cerebral vasogenic edema. All four patients had elevated blood pressure and renal injury in the days preceding PRES diagnosis, as well as evidence of systemic inflammation and systemic hypercoagulability. Symptoms of PRES improved with blood pressure control.ConclusionsOur four cases demonstrate the occurrence of PRES in critically-ill patients with COVID-19. PRES should be considered in the differential for acute neurological deficits and seizures in this setting.

Posterior reversible encephalopathy syndrome in patients with COVID-19