Shaking in Darkness: Posterior Reversible Encephalopathy Syndrome (PRES)-Induced Acute Bilateral Blindness and Seizures

Posterior reversible encephalopathy syndrome (PRES) is a neurologic disorder that causes acute or subacute cerebral edema, brain capillary leakage, and a hyperperfusion encephalopathy that results in presenting symptoms of headache, vision changes, seizure activity, altered mentation, nausea or vomiting, or focal neurologic deficits. We describe a case of PRES in the setting of severe hypertension presenting with total blindness and seizure activity in a patient with multiple risk factors. The patient had previous episodes of PRES in the past that led to the development of a seizure disorder. We also provide a summarization table of PRES pathophysiology, symptoms, risk factors, diagnostics, treatment, and sequelae. Early consideration and expedited diagnosis of PRES are paramount, as seizures and permanent deficits are avoidable with early treatment and intervention. Seizures occur in the majority of patients presenting with PRES and are associated with an increased risk of developing epilepsy, more so than those following strokes. Timely anti-hypertensives as well as anti-convulsant therapy form the basis of treatment for PRES, allowing for prompt treatment and hopefully avoidance of long-term sequelae, including seizure disorders and permanent neurologic deficits.