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Posterior reversible encephalopathy syndrome in an HIV-infected patient on antiretroviral treatment: what is the risk factor?
  1. Barbara Birner1,
  2. Cédric Hirzel2,
  3. Franca Wagner3,
  4. Gabriel Waldegg1
  1. 1Internal Medicine, Regionalspital Emmental AG, Burgdorf, Switzerland
  2. 2Infectious Diseases, Inselspital Universitatsspital Bern, Bern, Switzerland
  3. 3Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
  1. Correspondence to Dr Barbara Birner, barbara.birner{at}


Posterior reversible encephalopathy syndrome (PRES) is a rare but well-described syndrome associated with a high morbidity and a substantial mortality. We present an illustrative case of an HIV-infected but virologically suppressed patient who complained of visual impairment accompanied by severe headache and epileptic seizures. The cerebral CT scan and the follow-up cranial MRI confirmed the diagnosis of PRES. Unlike the cases of HIV-infected patients with PRES published so far, our patient suffered neither from advanced immunodeficiency nor from opportunistic infection or from any other evident predisposing factor. This case highlights that the absence of classical risk factors does not exclude the diagnosis of PRES. We discuss the hypothesis that in accordance with the new pathophysiological theory, persistent HIV-associated cerebrovascular reactivity in combination with endothelial dysfunction may represent an undetected risk factor for the development of PRES in virologically and immunologically stable patients.

  • hypertension
  • HIV / AIDS
  • epilepsy and seizures
  • neuroimaging

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  • Contributors BB collected all the references, wrote the main part of the case report and contributed to the study design. FW contributed to the part on neuroradiology and wrote the neuroradiology subsection. CH and GW were responsible for supervision and correction and also contributed to the background knowledge of HIV in our case.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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