Session Information
Session Title: AA 2021 Virtual Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Caroline M. Vail, DO: No financial relationships or conflicts of interest
Case Diagnosis: Patient with a recent traumatic cervical spinal cord injury and history of marijuana use who presented with severe headache and new visual deficits was found to have RCVS and PRES.
Case Description: An 18-year-old male with a C5 AIS A injury presented 1 month after acute inpatient rehabilitation to the emergency department with a severe headache lasting 1 week. Associated symptoms included blurry vision, sudden binocular vision loss, and hypertension. His prior course was notable for autonomic dysreflexia (AD) due to urinary tract infection. Since discharge, he did not regularly participate in his home intermittent catheterization program. He reports chronic daily marijuana smoking to help with his pain .
Setting: Tertiary care medical centerAssessment/
Results: Computerized tomography (CT) and magnetic resonance imaging (MRI) of the brain demonstrated multifocal vascular narrowing in anterior and posterior circulation as well as bilateral parietal/occipital diffusion restriction concerning for RCVS and PRES. CT brain showed hypoattenuation of bilateral occipital lobes. Visual acuity and visual field improved to patient’s baseline hours later. It is proposed that the patient, prone to blood pressure fluctuations, developed PRES and RCVS because of his AD from urinary retention. However in an effort to control his AD, he developed occipital lobe infarcts secondary to hypoperfusion.
Discussion: There is peer-reviewed literature describing marijuana as a significant cause of RCVS. AD is also a known trigger of RCVS. This is the first case to our knowledge in which there is the question of an additive effect of marijuana and AD on this patient. It also highlights the importance of AD prevention.
Conclusion: This patient developed RCVS, PRES, and subsequent bilateral occipital lobe infarcts in the setting of AD and marijuana. In a time of marijuana legalization in many states, as well as rising substance abuse during a pandemic, it is increasingly important to counsel future patients about the potential risks.
Level of Evidence: Level V
To cite this abstract in AMA style:
Vail CM, Vear AK. Case Report: Reversible Cerebral Vasoconstrictive Syndrome and Posterior Reversible Encephalopathy Syndrome from Autonomic Dysreflexia and Marijuana in a Patient with Cervical Spinal Cord Injury [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/case-report-reversible-cerebral-vasoconstrictive-syndrome-and-posterior-reversible-encephalopathy-syndrome-from-autonomic-dysreflexia-and-marijuana-in-a-patient-with-cervical-spinal-cord-injury/. Accessed May 21, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/case-report-reversible-cerebral-vasoconstrictive-syndrome-and-posterior-reversible-encephalopathy-syndrome-from-autonomic-dysreflexia-and-marijuana-in-a-patient-with-cervical-spinal-cord-injury/