LAUSR

The earliest description of posterior reversible encephalopathy syndrome (PRES) was given in 1996 by Hinchey et al1 as a diverse group of clinical and radiological findings characterized by headache, paresis, visual disturbances, seizures, and altered consciousness, along with radiological evidence of bilateral subcortical vasogenic edema that was more apparent on the posterior cerebral hemispheres. PRES is typically described after solid organ or bone marrow transplantation with the incidence being 0.5% to 5% and is most commonly associated with tacrolimus.2,3 The incidence of PRES following liver transplantation (LT) has been around 1%.3 PRES is also reported in cases of hypertensive encephalopathies, such as eclampsia and haemolysis, elevated liver enzymes, and low platelet count syndrome.4 PRES is completely reversible in majority of the instances; however, incidences of some residual neurological impairment have been reported.5 It is important to promptly diagnose PRES, including atypical variants after LT, and initiate appropriate symptomatic treatment and management of immunosuppressive medications. Here, we report a patient with an unusual presentation of PRES with a brief review of literature. Institutional ethical committee approval was obtained. Our patient had clinical features of PRES with atypical radiological changes after living donor LT, which has not been reported to date. Our patient showed complete recovery with modification of immunosuppressive medications and supportive management.