Posterior Reversible Encephalopathy Syndrome Associated with Nab-Paclitaxel, Carboplatin, and Pembrolizumab: A Case Highlighting Cumulative Endothelial Toxicity

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by a broad spectrum of neurological manifestations. Non-contrast magnetic resonance imaging (MRI) remains the diagnostic gold standard tool, typically demonstrating vasogenic edema with a predilection for the parieto-occipital regions. Additional imaging modalities and laboratory investigations are often required to exclude alternative diagnoses. The exact pathophysiological mechanisms underlying PRES remain incompletely understood; however, multiple theories have been proposed, including endothelial dysfunction and cytotoxic injury, the latter being particularly relevant in cases associated with chemotherapeutic agents. Management is primarily supportive, encompassing symptomatic treatment, seizure control with antiepileptic drugs, prevention of secondary brain injury, and maintenance of hemodynamic stability. While most patients experience complete neurological recovery with favorable outcomes, a subset develops significant morbidity or mortality. Early recognition of high-risk patients is therefore crucial to prevent catastrophic neurological sequelae.