Posterior Reversible Encephalopathy Syndrome With Spinal Cord Involvement 2 Months After a Burn Injury

A 20-year-old woman with burns (41% surface area) presented 2 months later with blurry vision, neurogenic bladder, weakness, and new hypertension. Examination revealed bilateral cotton wool spots and macular edema. MRI showed nonenhancing, edematous lesions from the brainstem to the conus medullaris. Differential included demyelinating disease, acute disseminated encephalomyelitis, and her final diagnosis PRES-SCI. Rheumatologic, infectious, and autoimmune workup were negative. She received IV nicardipine, immunoglobulin, and methylprednisone. Three months later, her weakness and lesions resolved (Figure). Recognizing the features of PRES-SCI with hypertension, retinopathy, and extensive spinal lesions can prevent immunosuppression.1 Hypertension is a long-term sequela of burns.2

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