Unveiling the link: Takayasu arteritis manifesting as posterior reversible encephalopathy syndrome

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare complication of Takayasu arteritis. A 19-year-old boy presented with headache on and off since childhood which has increased in intensity in the past 1 month and syncope for 3 days. Neuroimaging revealed symmetrical areas of hyperintensities in bilateral basal ganglia with no diffusion restriction. With the clinical history of hypertension, the possibility of Central variant of PRES was considered. Further imaging revealed more than 90% stenosis of right renal artery, mural thickening of aorta and bilateral subclavian artery stenosis. The combination of subclavian bruit with blood pressure difference between both arms, mural thickening of aorta, bilateral subclavian artery and renal artery stenosis lead to the diagnosis of PRES secondary to Takayasu arteritis. Vascular surgeon opinion was sought and was advised renal revascularization due to high grade renal artery stenosis after resolution of inflammation. The patient was treated with oral steroids and antihypertensives with which he improved symptomatically. After a period of 5 months, the patient underwent Aortorenal bypass and had significant control of hypertension. Prompt treatment and appropriate intervention can avoid catastrophic complications including death.