Posterior Reversible Encephalopathy Syndrome (PRES) in an Elderly Patient with Parkinson's Disease and Blood Pressure Fluctuations: A Case Report

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Abdelradi, Awad Al Harbi, Eyas Alsuhaibani, Tibyan Amir This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8294763/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological disorder defined by headache, altered mental status, seizures, and visual disturbances, coupled with neuroimaging showing vasogenic edema mainly in the parieto-occipital regions. Blood pressure fluctuation is common in Parkinson’s disease (PD) due to autonomic dysfunction affecting blood pressure regulation. Additionally, PD medications may contribute to episodes of both low and high blood pressure. We report an 82-year-old female with longstanding PD who presented with decreased consciousness and unsteadiness, and whose MRI was characteristic of PRES. She had a history of fluctuating blood pressure with diurnal variation, a recognised autonomic dysfunction in PD. This case underscores a possible association between PD-related autonomic dysfunction and PRES. With appropriate blood pressure control, the patient improved clinically and radiologically. This report also briefly reviews PRES in elderly patients, autonomic dysfunction in PD, and management considerations in such complex cases. Posterior Leukoencephalopathy Syndrome Parkinson Disease Autonomic Nervous System Diseases Blood Pressure Figures Figure 1 Figure 2 Figure 3 BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder primarily characterized by motor symptoms such as tremor, rigidity, bradykinesia, and postural instability [ 16 ]. However, non-motor symptoms, including autonomic dysfunction, are increasingly recognized as significant components of the disease [ 16 ]. Among these autonomic dysfunctions, blood pressure (BP) abnormalities such as orthostatic hypotension (OH), postprandial hypotension, and nocturnal hypertension are well-documented [ 3 , 4 , 8 , 9 , 14 , 17 ]. Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity characterized by headache, altered mental status, seizures, and visual disturbances, along with neuroimaging findings of vasogenic edema predominantly in the parieto-occipital regions. The pathophysiology of PRES is not completely understood but is thought to involve disordered autoregulation of cerebral blood flow leading to hyperperfusion, endothelial dysfunction, and fluid extravasation into the brain parenchyma [ 2 ]. The association between Parkinson's disease, blood pressure fluctuations, and PRES has not been extensively reported in the literature. This case report aims to highlight this potential relationship and discuss the clinical implications. CASE PRESENTATION The patient is an 82-year-old woman with a 10-year history of PD. Her PD was initially managed with levodopa/carbidopa, which provided adequate control of her motor symptoms. Over the years, she developed various non-motor symptoms, including blood pressure fluctuations with diurnal variation. She had documented episodes of both hypertension (BP > 180/100 mmHg) and hypotension (BP < 90/60 mmHg), particularly when standing. Her other medical history included mild cognitive impairment and occasional constipation, which are common non-motor manifestations of PD. She had no known history of renal disease, autoimmune disorders, or recent medication changes. The patient was brought to the emergency department by her family with a one-day history of altered level of consciousness (LOC), headache, and elevated blood pressure. According to her family, she had been her usual self until the previous day, when she became increasingly drowsy, confused, and complained of a severe headache. They also noted that her blood pressure was significantly higher than her usual readings. There was no reported history of recent head trauma, falls, seizures, or new medications. At the initial presentation, she was not responding to verbal commands with inability to open her eyes spontaneously. She only responded to verbal stimulus; she had marked rigidity and was bedbound for more than 9 months due to advanced Parkinson’s symptoms. The blood pressure at presentation was 119/79, due to a low Glasgow-coma score (GCS) of 3/15, with pupils 2mm symmetric and reactive to light. She was intubated and was sedated with fentanyl for 24 hours, which was then stopped but she remained with a low GCS score. computed tomography (CT) brain and MRI brain (See Figure 1, 2, 3). Electroencephalography (EEG) showed diffuse delta waves slowing with no electrographic seizure. Cerebrospinal fluid (CSF) showed normal white blood cell (WBC) count, protein and glucose. Two weeks later, GCS score improved to 7/15 however she was required to secure the airway and tracheostomy was placed for that purpose. The importance of this case report is to bring attention to the autonomic changes in blood pressure in patients with advanced Parkinson’s disease and that it may lead to complications that are uncommon such as posterior reversible encephalopathy syndrome (PRES). DISCUSSION AND CONCLUSION Although autonomic manifestations are common in Parkinson’s disease, the relationship between blood pressure fluctuations and Parkinson’s disease remains insufficiently understood and inadequately documented. To define, Blood pressure fluctuations include Orthostatic hypotension (OH), supine hypertension, or loss of circadian blood pressure regularity, and are symptoms of dysautonomia in Parkinson’s disease (PD) [12]. Alternating orthostatic hypotension and supine hypertension during the day, “reduced dipping”, and loss or return of the typical drop in blood pressure during sleep, “reverse dipping,” are included when BP fluctuation is mentioned [10]. Many articles have studied the association between BP fluctuations and PD [1,6,12]. In addition, a study mentioned a decrease in mean systolic blood pressure SBP in patients with PD [15]. While there are several pathophysiological theories linking the two, some have focused on autonomic dysfunction in PD [12]. His study noted that circadian rhythm disruption in patients with PD is a major contributor to BP variation. Others agreed that sleep disturbances are a significant factor that may affect PD patients’ blood pressure at night [1]. This could be one of the risk factors in our patient, as she has suffered from PD for 10 years, affecting her circadian rhythm. In line with previously reported cases, our patient’s long-standing Parkinson’s disease with marked blood pressure fluctuation resembles the clinical patterns described in PD-associated PRES [11]. Understanding how BP fluctuations contribute to PRES development is crucial for diagnosis and management. According to Hinduja , fluctuations in blood pressure are a common cause of PRES [5]. This is due to the distribution of cerebral autoregulation. An abrupt surge in blood pressure overwhelms the compensatory response of cerebral vessels, leading to hyperperfusion, disruption of the blood–brain barrier, and vasogenic oedema. The posterior circulation is especially vulnerable due to the reduced sympathetic innervation. Moreover, blood pressure fluctuations are associated with an increased risk of PRES, rather than mere BP elevation. This pathophysiological cascade is characteristic of PRES and aligns with the patient’s acute presentation with headache, reduced level of consciousness, and low GCS. In turn, the interaction between PD-related dysautonomia and chronic BP variability provides a reasonable explanation for the development of PRES in our case of an 82-year-old patient in the absence of usual triggers like vasopressors [5]. Despite some reports’ efforts to highlight the link between BP variability and cerebrovascular complications in PD, or the association with age, only a few focus on the relationship between BP variability, Parkinson’s disease, and PRES (Table 1). Our case highlights the possibility of PRES being caused by BP variability (not confined to orthostatic) in a patient with long-standing PD. Clinicians should be aware of the high prevalence of autonomic dysfunction in PD, including blood pressure fluctuations, and their potential serious consequences. Regular blood pressure monitoring and appropriate management of both hypertensive and hypotensive episodes are essential in PD patients. PRES should be considered in the differential diagnosis when PD patients present with altered mental status and hypertension, as early recognition and treatment can lead to favorable outcomes. Further research is needed to better understand the relationship between autonomic dysfunction in PD and the development of PRES, and to establish optimal management strategies for blood pressure fluctuations in this vulnerable population. Abbreviations PD Parkinson’s disease PRES Posterior Reversible Encephalopathy Syndrome BP Blood Pressure OH Orthostatic Hypotension LOC Level of Consciousness GCS Glasgow-Coma Score CT Computed Tomography MRI Magnetic Resonance Imaging EEG Electroencephalography CSF Cerebrospinal Fluid WBC White Blood Cell SBP Systolic Blood Pressure Declarations Ethics approval and consent to participate Since this is a retrospective case report describing the clinical course of a single patient, formal ethics approval from an Institutional Review Board (IRB) or Ethics Committee may be considered waived according to institutional policy for such non-research reports, provided the report maintains patient anonymity. The need for formal ethics approval was deemed unnecessary by the authors' institution/department for this type of publication. Consent for publication Verbal informed consent was obtained from the patient’s legally authorized representative (e.g., family member or guardian) for the publication of this case report, including all accompanying clinical details and neuroimaging findings (Figures 1, 2, 3), ensuring their anonymity and privacy were protected. Availability of data and materials All data relevant to this case report, including the patient's de-identified clinical history and the original neuroimaging findings (as visually represented in Figures 1, 2, and 3), are contained within the manuscript. The minimal dataset necessary to interpret and build upon the findings of this case report consists of the clinical course, physical examination findings, blood pressure data, laboratory results (CSF, EEG), and the characteristic MRI images. Due to the requirement to protect the individual privacy and patient confidentiality of this single case, the full raw patient data and non-anonymized records are not publicly archived. Competing interests The authors declare that they have no financial or non-financial competing interests that could inappropriately influence or bias the findings or interpretation of this case report. Funding Nil Authors' contributions AAH was responsible for the Conceptualization, establishing the Methodology, and the Visualization of the case report. EA performed the Data curation. MUA was responsible for the Formal analysis, Project administration, and the Writing – review & editing of the manuscript. TA performed the Writing – original draft. Acknowledgements Not applicable References Alves M, Caldeira D, Ferreira JJ. Blood pressure variability in Parkinson’s disease patients: Case-control study. Clin Parkinsonism Relat Disord 2023;8:100191. doi:10.1016/j.prdoa.2023.100191 Fugate J, Lindquist KA, Barrett LF. Handbook of social and language chapter [Internet]. 2015 Mar 27 [cited 2025 Nov 06]. Available from: https://www.researchgate.net/publication/274074759 Goldstein DS, Eldadah B, Holmes C, Pechnik S, Moak J, Saleem A, Sharabi Y. Neurocirculatory abnormalities in Parkinson disease with orthostatic hypotension: independence from levodopa treatment. Hypertension 2005;46(6):1333–1339. doi:10.1161/01.HYP.0000188052.69549.e4 Gross CG, Rocha-Miranda CE, Bender DB. Visual properties of neurons in inferotemporal cortex of the macaque. J Neurophysiol 1972;35(1):96–111. doi:10.1152/jn.1972.35.1.96 Hinduja A. Posterior reversible encephalopathy syndrome: Clinical features and outcome. Front Neurol 2020;11:71. doi:10.3389/fneur.2020.00071 Kanegusuku H, Ebersbach G, Stoeck M, Müller J, Wissel J, Poewe W. Patients with Parkinson disease present high ambulatory blood pressure variability. Clin Physiol Funct Imaging 2016;37(6):530–5. doi:10.1111/cpf.12338 Lewi Shen , Yang X, Lu W, Chen W, Ye X, Wu D. 24-hour ambulatory blood pressure alterations in patients with Parkinson's disease. Brain Behav 2021;11:e2428. doi:10.1002/brb3.2428 Lutterveld R, Sommer IEC, Ford JM. The neurophysiology of auditory hallucinations: A historical and contemporary review. Front Psychiatry 2011;2:28. doi:10.3389/fpsyt.2011.00028 Luciano M, Batty GD, McGilchrist M, Linksted P, Fitzpatrick B, Jackson C, et al. Shared genetic aetiology between cognitive ability and cardiovascular disease risk factors. Intelligence 2010;38(3):304–13. doi:10.1016/j.intell.2010.03.002 Milazzo V, Di Stefano C, Vallelonga F, Sobrero G, Zibetti M, Romagnolo A, et al. Reverse blood pressure dipping as a marker of dysautonomia in Parkinson's disease. Parkinsonism Relat Disord 2019;56: doi:10.1016/j.parkreldis.2018.12.015 Morozumi S, Kato S, Yasui K, Hasegawa Y. A case of advanced Parkinson’s disease with severe supine hypertension and blood pressure fluctuations leading to posterior reversible encephalopathy syndrome. Clin Neurol 2016;56(11):754–8. doi:10.5692/clinicalneurol.cn-000907 Pierzchlińska A, Kwaśniak-Butowska M, Sławek J, Droździk M, Białecka M. Arterial blood pressure variability and vascular factors contributing to cognitive decline in Parkinson’s disease. Molecules 2021;26(6):1523. doi:10.3390/molecules26061523 Riley DE, Espay AJ. Cognitive fluctuations in Parkinson’s disease dementia: Blood pressure lability as an underlying mechanism. J Clin Mov Disord 2018;5:1. doi:10.1186/s40734-018-0068-4 Sharabi Y, Goldstein DS. Mechanisms of orthostatic hypotension and supine hypertension in Parkinson disease. J Neurol Sci 2011;310(1–2):123–8. doi:10.1016/j.jns.2011.06.047 Shindo K, Morishima Y, Suwa Y, Fukao T, Kurita T, Satake A, et al. Age-related changes in blood pressure and heart rate of patients with Parkinson’s disease. J Clin Hypertens (Greenwich) 2021;23(1):175–8. doi:10.1111/jch.14096 Ziemssen T, Reichmann H. Non-motor dysfunction in Parkinson’s disease. Parkinsonism Relat Disord 2007;13(6):323–32. doi:10.1016/j.parkreldis.2006.12.014 Ziemssen T, Reichmann H. Cardiovascular autonomic dysfunction in Parkinson’s disease. J Neurol Sci 2010;289(1–2):74–80. doi:10.1016/j.jns.2009.08.031 Table Table 1. Compares published PRES case reports and investigations of PD-related autonomic dysfunction [1,2,5,6,7,10-13]. Author(s), Year Type (Case / Study / Review) Patient(s) / Sample Size, Age & Sex Key Details (BP variability, PD, PRES relationship) and Outcome Reference number Alves M. et al. 2023 Case-control study — Suggests that PD patients may present a higher blood pressure variability. 1 Fugate, 2015 Review — Suggested that PRES can be caused by BP fluctuation, regardless of the underlying cause 2 Hinduja 2015 Review of PRES mechanisms — Established rapid BP rise and impaired autoregulation as the core mechanism of PRES; highlighted posterior circulation vulnerability due to less sympathetic innervation. 5 Kanegusuku, 2016 Case-control 21 patients with PD Patients with Parkinson's disease (PD) present a blunted nocturnal blood pressure fall and similar ambulatory blood pressure variability (ABPV), assessed by standard deviation. 6 Shen,2021 Cross-sectional 32 patients with PD Noted that reverse dipping (a pattern of BP variability) was more common in PD patients in this study, especially in the advanced PD patients. 7 Milazzo V. et al. 2018 Cross-sectional study — Studied the association between abnormal circadian BP profile and autonomic dysautonomia in PD. 10 Morozumi et al., 2016 Case report 77-year-old man with 10-year PD PRES attributed to extreme BP fluctuation: orthostatic hypotension + supine hypertension; suggested PD-related autonomic failure as trigger. The only case with a similar background and presentation to our case. 11 Pierzchlińska, 2019 Review — Studied the effect of circadian rhythm on BP variability in patients with PD 12 Riley, 2018 Case report 86-year-old man with PD BP variability in PD contributes to end-organ damage, including cognition and possibly disautonomia 13 Current Case 2025 Case Report 82-year-old woman with PD Presented with Autonomic dysfunction. The authors suggest that untreated autonomic changes in PD may lead to PRES. New Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8294763","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":556721252,"identity":"0a141451-4b12-40c4-859c-25c885a30146","order_by":0,"name":"Moustafa U. 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04:48:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":294445,"visible":true,"origin":"","legend":"\u003cp\u003eProgression of the bilateral medial occipito-temporal lobes hypodensities with bilateral thalami involvement. Patent basilar and bilateral posterior cerebral arteries.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8294763/v1/3d1605d2e8105214ec07f143.png"},{"id":97897229,"identity":"45fc1681-9d22-4f7f-b01d-b27f94f4e74d","added_by":"auto","created_at":"2025-12-10 15:37:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":189996,"visible":true,"origin":"","legend":"\u003cp\u003eBilateral medial occipito-temporal lobes, thalami and midbrain T2 hyperintensities with diffusion restriction, foci of susceptibility effect and patchy enhancement.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8294763/v1/ccba735198db8e3c9df2aa00.png"},{"id":97962968,"identity":"7d32f608-8442-457c-a075-b7e6e4d26f7b","added_by":"auto","created_at":"2025-12-11 09:09:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":991066,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8294763/v1/92e8b575-aaee-49ca-896e-295390f3fcfe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Posterior Reversible Encephalopathy Syndrome (PRES) in an Elderly Patient with Parkinson's Disease and Blood Pressure Fluctuations: A Case Report","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eParkinson's disease (PD) is a progressive neurodegenerative disorder primarily characterized by motor symptoms such as tremor, rigidity, bradykinesia, and postural instability [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, non-motor symptoms, including autonomic dysfunction, are increasingly recognized as significant components of the disease [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Among these autonomic dysfunctions, blood pressure (BP) abnormalities such as orthostatic hypotension (OH), postprandial hypotension, and nocturnal hypertension are well-documented [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological entity characterized by headache, altered mental status, seizures, and visual disturbances, along with neuroimaging findings of vasogenic edema predominantly in the parieto-occipital regions. The pathophysiology of PRES is not completely understood but is thought to involve disordered autoregulation of cerebral blood flow leading to hyperperfusion, endothelial dysfunction, and fluid extravasation into the brain parenchyma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The association between Parkinson's disease, blood pressure fluctuations, and PRES has not been extensively reported in the literature. This case report aims to highlight this potential relationship and discuss the clinical implications.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eThe patient is an 82-year-old woman with a 10-year history of PD. Her PD was initially managed with levodopa/carbidopa, which provided adequate control of her motor symptoms. Over the years, she developed various non-motor symptoms, including blood pressure fluctuations with diurnal variation. She had documented episodes of both hypertension (BP \u0026gt; 180/100 mmHg) and hypotension (BP \u0026lt; 90/60 mmHg), particularly when standing. Her other medical history included mild cognitive impairment and occasional constipation, which are common non-motor manifestations of PD. She had no known history of renal disease, autoimmune disorders, or recent medication changes.\u003c/p\u003e\n\u003cp\u003eThe patient was brought to the emergency department by her family with a one-day history of altered level of consciousness (LOC), headache, and elevated blood pressure. According to her family, she had been her usual self until the previous day, when she became increasingly drowsy, confused, and complained of a severe headache. They also noted that her blood pressure was significantly higher than her usual readings. There was no reported history of recent head trauma, falls, seizures, or new medications. At the initial presentation, she was not responding to verbal commands with inability to open her eyes spontaneously. She only responded to verbal stimulus; she had marked rigidity and was bedbound for more than 9 months due to advanced Parkinson’s symptoms. The blood pressure at presentation was 119/79, due to a low Glasgow-coma score (GCS) of 3/15, with pupils 2mm symmetric and reactive to light. She was intubated and was sedated with fentanyl for 24 hours, which was then stopped but she remained with a low GCS score. computed tomography (CT) brain and MRI brain (See Figure 1, 2, 3). Electroencephalography (EEG) showed diffuse delta waves slowing with no electrographic seizure. Cerebrospinal fluid (CSF) showed normal white blood cell (WBC) count, protein and glucose. \u0026nbsp;Two weeks later, GCS score improved to 7/15 however she was required to secure the airway and tracheostomy was placed for that purpose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe importance of this case report is to bring attention to the autonomic changes in blood pressure in patients with advanced Parkinson’s disease and that it may lead to complications that are uncommon such as posterior reversible encephalopathy syndrome (PRES).\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION AND CONCLUSION","content":"\u003cp\u003eAlthough autonomic manifestations are common in Parkinson’s disease, the relationship between blood pressure fluctuations and Parkinson’s disease remains insufficiently understood and inadequately documented. To define, Blood pressure fluctuations include Orthostatic hypotension (OH), supine hypertension, or loss of circadian blood pressure regularity, and are symptoms of dysautonomia in Parkinson’s disease (PD) [12]. Alternating orthostatic hypotension and supine hypertension during the day, “reduced dipping”, and loss or return of the typical drop in blood pressure during sleep, “reverse dipping,” are included when BP fluctuation is mentioned [10].\u003c/p\u003e\n\u003cp\u003eMany articles have studied the association between BP fluctuations and PD [1,6,12]. In addition, a study mentioned a decrease in mean systolic blood pressure SBP in patients with PD [15]. While there are several pathophysiological theories linking the two, some have focused on autonomic dysfunction in PD [12]. His study noted that circadian rhythm disruption in patients with PD is a major contributor to BP variation. Others agreed that sleep disturbances are a significant factor that may affect PD patients’ blood pressure at night [1]. This could be one of the risk factors in our patient, as she has suffered from PD for 10 years, affecting her circadian rhythm.\u003c/p\u003e\n\u003cp\u003eIn line with previously reported cases, our patient’s long-standing Parkinson’s disease with marked blood pressure fluctuation resembles the clinical patterns described in PD-associated PRES [11]. Understanding how BP fluctuations contribute to PRES development is crucial for diagnosis and management. According to Hinduja , fluctuations in blood pressure are a common cause of PRES [5]. This is due to the distribution of cerebral autoregulation. An abrupt surge in blood pressure overwhelms the compensatory response of cerebral vessels, leading to hyperperfusion, disruption of the blood–brain barrier, and vasogenic oedema. The posterior circulation is especially vulnerable due to the reduced sympathetic innervation. Moreover, blood pressure fluctuations are associated with an increased risk of PRES, rather than mere BP elevation. This pathophysiological cascade is characteristic of PRES and aligns with the patient’s acute presentation with headache, reduced level of consciousness, and low GCS. In turn, the interaction between PD-related dysautonomia and chronic BP variability provides a reasonable explanation for the development of PRES in our case of an 82-year-old patient in the absence of usual triggers like vasopressors [5].\u003c/p\u003e\n\u003cp\u003eDespite some reports’ efforts to highlight the link between BP variability and cerebrovascular complications in PD, or the association with age, only a few focus on the relationship between BP variability, Parkinson’s disease, and PRES (Table 1). Our case highlights the possibility of PRES being caused by BP variability (not confined to orthostatic) in a patient with long-standing PD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinicians should be aware of the high prevalence of autonomic dysfunction in PD, including blood pressure fluctuations, and their potential serious consequences. Regular blood pressure monitoring and appropriate management of both hypertensive and hypotensive episodes are essential in PD patients. PRES should be considered in the differential diagnosis when PD patients present with altered mental status and hypertension, as early recognition and treatment can lead to favorable outcomes. Further research is needed to better understand the relationship between autonomic dysfunction in PD and the development of PRES, and to establish optimal management strategies for blood pressure fluctuations in this vulnerable population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eParkinson\u0026rsquo;s disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePRES\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePosterior Reversible Encephalopathy Syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBP\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBlood Pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eOH\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOrthostatic Hypotension\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eLOC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLevel of Consciousness\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eGCS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlasgow-Coma Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCT\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eMRI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eEEG\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eElectroencephalography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCSF\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCerebrospinal Fluid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eWBC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWhite Blood Cell\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSystolic Blood Pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince this is a retrospective case report describing the clinical course of a single patient, formal ethics approval from an Institutional Review Board (IRB) or Ethics Committee may be considered waived according to institutional policy for such non-research reports, provided the report maintains patient anonymity. The need for formal ethics approval was deemed unnecessary by the authors' institution/department for this type of publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal informed consent was obtained from the patient’s legally authorized representative (e.g., family member or guardian) for the publication of this case report, including all accompanying clinical details and neuroimaging findings (Figures 1, 2, 3), ensuring their anonymity and privacy were protected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data relevant to this case report, including the patient's de-identified clinical history and the original neuroimaging findings (as visually represented in Figures 1, 2, and 3), are contained within the manuscript. The minimal dataset necessary to interpret and build upon the findings of this case report consists of the clinical course, physical examination findings, blood pressure data, laboratory results (CSF, EEG), and the characteristic MRI images. Due to the requirement to protect the individual privacy and patient confidentiality of this single case, the full raw patient data and non-anonymized records are not publicly archived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or non-financial competing interests that could inappropriately influence or bias the findings or interpretation of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAAH was responsible for the Conceptualization, establishing the Methodology, and the Visualization of the case report. EA performed the Data curation. MUA was responsible for the Formal analysis, Project administration, and the Writing – review \u0026amp; editing of the manuscript. TA performed the Writing – original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlves M, Caldeira D, Ferreira JJ. Blood pressure variability in Parkinson\u0026rsquo;s disease patients: Case-control study. \u003cem\u003eClin Parkinsonism Relat Disord\u003c/em\u003e 2023;8:100191. doi:10.1016/j.prdoa.2023.100191\u003c/li\u003e\n \u003cli\u003eFugate J, Lindquist KA, Barrett LF. Handbook of social and language chapter [Internet]. 2015 Mar 27 [cited 2025 Nov 06]. Available from: https://www.researchgate.net/publication/274074759\u003c/li\u003e\n \u003cli\u003eGoldstein DS, Eldadah B, Holmes C, Pechnik S, Moak J, Saleem A, Sharabi Y. 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Arterial blood pressure variability and vascular factors contributing to cognitive decline in Parkinson\u0026rsquo;s disease. \u003cem\u003eMolecules\u003c/em\u003e 2021;26(6):1523. doi:10.3390/molecules26061523\u003c/li\u003e\n \u003cli\u003eRiley DE, Espay AJ. Cognitive fluctuations in Parkinson\u0026rsquo;s disease dementia: Blood pressure lability as an underlying mechanism. \u003cem\u003eJ Clin Mov Disord\u003c/em\u003e 2018;5:1. doi:10.1186/s40734-018-0068-4\u003c/li\u003e\n \u003cli\u003eSharabi Y, Goldstein DS. Mechanisms of orthostatic hypotension and supine hypertension in Parkinson disease. \u003cem\u003eJ Neurol Sci\u003c/em\u003e 2011;310(1\u0026ndash;2):123\u0026ndash;8. doi:10.1016/j.jns.2011.06.047\u003c/li\u003e\n \u003cli\u003eShindo K, Morishima Y, Suwa Y, Fukao T, Kurita T, Satake A, et al. Age-related changes in blood pressure and heart rate of patients with Parkinson\u0026rsquo;s disease.\u003cem\u003e\u0026nbsp;J Clin Hypertens (Greenwich)\u0026nbsp;\u003c/em\u003e2021;23(1):175\u0026ndash;8. doi:10.1111/jch.14096\u003c/li\u003e\n \u003cli\u003eZiemssen T, Reichmann H. Non-motor dysfunction in Parkinson\u0026rsquo;s disease. \u003cem\u003eParkinsonism Relat Disord\u003c/em\u003e 2007;13(6):323\u0026ndash;32. doi:10.1016/j.parkreldis.2006.12.014\u003c/li\u003e\n \u003cli\u003eZiemssen T, Reichmann H. Cardiovascular autonomic dysfunction in Parkinson\u0026rsquo;s disease. \u003cem\u003eJ Neurol Sci\u003c/em\u003e 2010;289(1\u0026ndash;2):74\u0026ndash;80. doi:10.1016/j.jns.2009.08.031\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable\u0026nbsp;1. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCompares published PRES case reports and investigations of PD-related autonomic dysfunction [1,2,5,6,7,10-13].\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"93%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eAuthor(s), Year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eType (Case / Study / Review)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.8841%;\"\u003e\n \u003cp\u003ePatient(s) / Sample Size, Age \u0026amp; Sex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eKey Details (BP variability, PD, PRES relationship) and Outcome\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003eReference number\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eAlves M. et al. 2023\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCase-control study\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eSuggests that PD patients may present a higher blood pressure variability.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eFugate, 2015\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eReview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eSuggested that PRES can be caused by BP fluctuation, regardless of the underlying cause\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eHinduja 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eReview of PRES mechanisms\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eEstablished rapid BP rise and impaired autoregulation as the core mechanism of PRES; highlighted posterior circulation vulnerability due to less sympathetic innervation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eKanegusuku, 2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCase-control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e21 patients with PD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003ePatients with Parkinson\u0026apos;s disease (PD) present a blunted nocturnal blood pressure fall and similar ambulatory blood pressure variability (ABPV), assessed by standard deviation.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eShen,2021\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e32 patients with PD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eNoted that reverse dipping (a pattern of BP variability) was more common in PD patients in this study, especially in the advanced PD patients.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eMilazzo V. et al. 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCross-sectional study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eStudied the association between abnormal circadian BP profile and autonomic dysautonomia in PD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eMorozumi et al., 2016\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCase report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e77-year-old man with 10-year PD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003ePRES attributed to extreme BP fluctuation: orthostatic hypotension + supine hypertension; suggested PD-related autonomic failure as trigger. The only case with a similar background and presentation to our case.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003ePierzchlińska, 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eReview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eStudied the effect of circadian rhythm on BP variability in patients with PD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eRiley, 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCase report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e86-year-old man with PD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003eBP variability in PD contributes to end-organ damage, including cognition and possibly disautonomia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.1768%;\"\u003e\n \u003cp\u003eCurrent Case\u003c/p\u003e\n \u003cp\u003e2025\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3796%;\"\u003e\n \u003cp\u003eCase Report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.8841%;\"\u003e\n \u003cp\u003e82-year-old woman with PD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7762%;\"\u003e\n \u003cp\u003ePresented with Autonomic dysfunction. The authors suggest that untreated autonomic changes in PD may lead to PRES.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7832%;\"\u003e\n \u003cp\u003eNew\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Posterior Leukoencephalopathy Syndrome, Parkinson Disease, Autonomic Nervous System Diseases, Blood Pressure","lastPublishedDoi":"10.21203/rs.3.rs-8294763/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8294763/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePosterior Reversible Encephalopathy Syndrome (PRES) is a neurological disorder defined by headache, altered mental status, seizures, and visual disturbances, coupled with neuroimaging showing vasogenic edema mainly in the parieto-occipital regions. Blood pressure fluctuation is common in Parkinson\u0026rsquo;s disease (PD) due to autonomic dysfunction affecting blood pressure regulation. Additionally, PD medications may contribute to episodes of both low and high blood pressure. We report an 82-year-old female with longstanding PD who presented with decreased consciousness and unsteadiness, and whose MRI was characteristic of PRES. She had a history of fluctuating blood pressure with diurnal variation, a recognised autonomic dysfunction in PD. This case underscores a possible association between PD-related autonomic dysfunction and PRES. With appropriate blood pressure control, the patient improved clinically and radiologically. This report also briefly reviews PRES in elderly patients, autonomic dysfunction in PD, and management considerations in such complex cases.\u003c/p\u003e","manuscriptTitle":"Posterior Reversible Encephalopathy Syndrome (PRES) in an Elderly Patient with Parkinson's Disease and Blood Pressure Fluctuations: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-09 04:48:10","doi":"10.21203/rs.3.rs-8294763/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ca634ad-8ba2-4915-a0b3-a6e4ff855e9e","owner":[],"postedDate":"December 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-11T09:08:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-09 04:48:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8294763","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8294763","identity":"rs-8294763","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}