Hemorrhagic PRES: A Rare Neurological Manifestation of COVID -19 Infection

Abstract

As of August 2021, the COVID -19 pandemic has affected approximately 200 million cases worldwide. Most of the reported medical literature about the COVID-19 infection discusses its respiratory and haematological manifestations, with limited information about its neurological complications. Encephalitis, meningitis, acute disseminated encephalomyelitis, stroke and encephalopathy have been reported in patients with COVID-19 infection. Symptomatology of CNS involvement includes dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures. Encephalopathy is encountered commonly in patients with severe disease, multi-organ dysfunction and elevated inflammatory markers. Acute cerebrovascular disease is another major manifestation of COVID -19 infection and is mainly due to occlusion of large vessels, hypercoagulability and a pro-inflammatory state. In this report, we discuss the diagnosis and outcome of a 30-year-old patient detected with Posterior Reversible Encephalopathy Syndrome (PRES) as a complication of COVID-19 infection. We hope this report will provide physicians with a useful framework for understanding pathophysiology and imaging findings of PRES in COVID-19 infection.