Cocaine-Induced Posterior Reversible Encephalopathy Syndrome: Two Case Reports

Abstract Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by acute neurological symptoms and reversible vasogenic edema, predominantly affecting the posterior cerebral regions. Cocaine is a recognized but uncommon trigger of PRES. We report two female patients who developed PRES following recent cocaine use. The first presented with acute confusion, agitation, and severe hypertension, while the second presented with cortical blindness, altered mental status, hypertension, and acute kidney injury. Neuroimaging in both cases revealed bilateral parieto-occipital white matter edema on magnetic resonance imaging, consistent with PRES. Both patients were managed with gradual blood pressure control and supportive therapy, resulting in complete clinical recovery within 48 h. These cases highlight cocaine as an important and potentially under-recognized precipitant of PRES. Early recognition, appropriate neuroimaging, and prompt blood pressure control are essential for favorable outcomes. Increased awareness may reduce misdiagnosis and under-reporting of cocaine-induced PRES.