From Clonidine Withdrawal to Posterior Reversible Encephalopathy Syndrome: Imaging and Cerebrospinal Fluid Clues in a Case of Hypertensive Emergency

We report the case of a 33-year-old man who developed posterior reversible encephalopathy syndrome (PRES) after clonidine withdrawal, which led to a hypertensive crisis. The patient presented with rapid neurologic decline, including vision loss and confusion. Due to the initial unavailability of magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis revealing albuminocytologic dissociation was pivotal in establishing the diagnosis. Subsequent MRI confirmed parieto-occipital hyperintensities, solidifying the PRES diagnosis. This case underscores the diagnostic value of CSF analysis in rapidly evolving neurologic conditions when MRI is delayed or unavailable and highlights the risk for PRES as a complication of clonidine withdrawal.