Hypercalcemia-Associated Posterior Reversible Encephalopathy Syndrome

Malignant Hypercalcemia: A Rare Etiology of Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome (PRES) is a rare and severe neurotoxic encephalopathic state characterized by variable neurologic manifestations ranging from headache and confusion to seizures, coma, and reversible subcortical vasogenic edema on imaging. PRES is commonly induced by chronic renal failure, hypertension, chemotherapeutic drugs, and eclampsia. PRES induced by hypercalcemia is uncommon and not widely underlined in the literature. We underline a case of a 61-year-old female diagnosed with advanced breast carcinoma presented with altered sensorium and generalized limb weakness. She was found to have malignant hypercalcemia, and brain imaging demonstrated subcortical vasogenic edema in the occipital and frontal lobe, suggestive of PRES. Her condition gradually improved after the treatment of hypercalcemia.

Comment on “Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report”

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state, manifesting clinical symptoms of headache, altered consciousness, visual disturbances, and seizures. Although several diseases have been identified as causative of PRES, the underlying mechanism remains unclear. Song et al recently published “Posterior reversible encephalopathy syndrome (PRES) in a patient with metastatic breast cancer: A case report“ in the World Journal of Clinical Cases, highlighting and discussing the role of hypercalcemia in PRES as related to uncontrolled hypertension. To build upon this case description, we provide further insight into the possible underlying mechanisms of PRES through this commentary.