Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

The first definition of posterior reversible encephalopathy syndrome (PRES), dates back to 1996, when Hinchey described a reversible clinical-radiological syndrome characterized by acute onset of headache, nausea, dizziness, changes in consciousness, convulsions and transient visual disturbances such as cortical blindness and white matter oedema mainly localised in the occipital-parietal lobes (1,2). Magnetic resonance imaging (MRI) shows bilateral grey and white matter abnormalities predominantly in the posterior regions of the cerebral hemispheres and cerebellum (3). PRES is the result of multitude of factors and has been associated with numerous medical conditions. Hypertension and immunosuppressive or cytotoxic drugs have been reported to be the most significant causes of PRES (4)