Disclosures: John W. Lopez, DO: Nothing to disclose

Case Description: 2 male patients with spastic tetraplegia secondary to remote, traumatic, cervical spinal cord injury (SCI) developed autonomic dysreflexia (AD) with subsequent posterior reversible encephalopathy syndrome (PRES). Both were admitted to acute care hospital with multiple episodes of dysreflexia secondary to infectious source and seizures related to PRES. Brain magnetic resonance imaging (MRI) of both subjects revealed findings consistent with PRES. Both patients initially received antiepileptics and the underlying cause of AD was treated.

Setting: Acute inpatient rehabilitation hospital.

Patient: 40-year-old male with incomplete cervical SCI; 32-year-old male with complete cervical SCI.

Assessment/Results: Both patients progressed clinically but experienced functional decline. Following acute care treatment, they were admitted to inpatient rehabilitation. Acute rehabilitation was completed without complications and both patients returned to prior level of function.

Discussion: AD is a syndrome potentially affecting SCI patients, characterized by significant blood pressure elevation above baseline, sometimes with concomitant bradycardia. Sequelae include headaches, flushing above and piloerection below the level of lesion and occasionally seizures. PRES is a clinical and neuroradiographic syndrome involving headaches, encephalopathy, hallucinations, visual disturbances and seizures often associated with accelerated hypertension. Presence of vasogenic cerebral edema establishes the diagnosis of PRES when clinical manifestations suggest the syndrome. Cerebral edema, demonstrated by hyperintense T2 signals without restricted diffusion, occurs most frequently in parietal or occipital lobes. If treated promptly, symptoms of PRES and neuroimaging abnormalities usually resolve within a week. If PRES persists, permanent visual impairment, continued seizures, cognitive impairment and intracerebral hemorrhage can occur.

Conclusion: PRES can result from relative hypertension in SCI patients who develop AD. Despite similar sequela including seizures, PRES must be differentiated from AD for prompt treatment to prevent permanent side effects. Patients recovering from PRES may require inpatient rehabilitation to improve functional impairment. Traumatic SCI patients who develop PRES secondary to AD are capable of return to baseline function.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/autonomic-dysreflexia-induced-posterior-reversible-encephalopathy-syndrome-in-patients-with-spinal-cord-injury-a-case-series/