Posterior reversible encephalopathy syndrome (PRES) is a reversible neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. It is characterized by seizure, headaches, visual symptoms, impaired consciousness and other focal neurological findings. It is coupled with a unique CT or MR imaging appearance. Recurrent PRES has been reported in severe hypertension and after allo-BMT [1,2]. In a recent reported series, recurrent PRES was noted in 3.8% of patients [3]. We describe a case of 62 year old woman with chronic obstructive pulmonary disease and hypertension who presented with two days history of blurring of vision, altered sensorium, headache and developed 2 episodes of generalized tonic clonic seizures after coming to hospital. On MRI Brain, hyper intense lesions seen in the bilateral parieto-occipital lobes with diffusion restriction, suggesting possibility of Posterior Reversible Encephalopathy Syndrome. Patient had history of similar episode 17 months back. CECT brain done at that time had features persistent with Posterior Reversible Encephalopathy Syndrome.

Keywords: Posterior Reversible Encephalopathy Syndrome; Hypertension; Seizure; Recurrent PRES; Hypertensive Encephalopathy.