Rehabilitation potential of patients with posterior reversible encephalopathy syndrome (PRES): a case report of rare severe atypical manifestation mimicking metastasis and literature review

Abstract. Posterior reversible encephalopathy syndrome (PRES) involves clinical symptoms like headaches, altered consciousness, and radiological signs of brain edema. It can result from various conditions, including hypertensive crises and autoimmune diseases. Diagnosis relies on typical MRI findings. Prompt diagnosis, treatment and early rehabilitation are essential to prevent severe complications. We present a rare case of diagnostic dilema of severe type of PRES syndrome with diffuze hemorrhagic imbibition and large involvemet of meninges, mimicking metastatic brain involvement in patient with breast malignancy, not published before. Use of performant MRI sequences, as are neuroperfusion and spectroscopy, permited to make the correct diagnosis, that was confirmed in follow-up multiparametric MRI scan after 1 month. Follow-up images confirmed susbtotal regression of brain and meningeal lesions, alongside with good clinical evolution. PRES pathogenesis involves vascular wall damage, leading to plasma and macromolecule leakage into the brain's interstitial tissue. Detection, treatment, and control of the underlying cause, in addition to careful correction of hypertension, are crucial for treating PRES. A favorable prognosis is expected with early recognition and treatment, with symptoms improving or resolving within days to weeks. Posterior reversible encephalopathy syndrome (PRES) presents unique challenges in terms of rehabilitation due to its diverse clinical manifestations and potential for neurological sequelae. While the primary focus of PRES management is on identifying and treating the underlying cause, rehabilitation plays a crucial role in optimizing functional outcomes and quality of life for affected individuals.