Posterior Reversible Encephalopathy Syndrome (PRES) and Intraventricular Hemorrhage in a Patient with Untreated Hypertension: A Case Report

Background Posterior Reversible Encephalopathy Syndrome (PRES) is a neurotoxic condition characterized by headache, altered mental status, seizures, and visual disturbances, frequently associated with vasogenic edema on neuroimaging. Although acute hypertension is a common precipitant, the occurrence of PRES with intracerebral hemorrhage is rare. This report documents this unusual combination, emphasizing its clinical significance. The limited prevalence of this presentation in published literature further underscores the importance of this case. Case presentation A 39-year-old male with a one-year history of untreated hypertension presented with severe headache, agitation, and decreased consciousness. On admission, blood pressure was critically elevated (≥ 200/110 mmHg). Initial computed tomography (CT) of the brain revealed extensive intraventricular hemorrhage (IVH) with hydrocephalus, necessitating emergency external ventricular drain (EVD) placement. Magnetic resonance imaging (MRI) confirmed PRES in the parieto-occipital regions. Aggressive antihypertensive therapy, supportive care, and multidisciplinary management led to significant neurological improvement. Conclusion This case illustrates a severe presentation of PRES, demonstrating its coexistence with hemorrhage. Early recognition of hypertensive emergencies, careful management of complications, and timely, multidisciplinary interventions are essential for favorable neurological outcomes.