Pregabalin Toxicity-Induced Posterior Reversible Encephalopathy Syndrome

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurological phenomenon in which vasogenic edema most commonly accumulates in the posterior parieto-occipital white matter[1]. It was caused by some drugs such as opioids [2,3] methadone [4] or gabapentin [5].  Rare cases of PRES-related pregabalin were reported [6,7].  It was typically used to treat neuropathic pain [4]. We present a unique case of a 23-year-old patient without any previous history admitted to intensive care for quadriplegic paralysis with Guillain-Barre syndrome. His neuropathic pain was treated with pregabalin.  He presented poorly balanced hypertension and a worsening of renal function due to colistin toxicity.  On day 52, he presented a sudden drop in visual acuity without altering his consciousness.  Cerebral MRI revealed subcortical white matter edema in the bilateral parietal and occipital lobes with T2 and Flair hyper signals without diffusion restriction suggestive of PRES. He was treated by controlling hypertension and by stopping pregabalin. The clinical course was favorable after 5 days, with a recovery of visual acuity. This case indicates that physicians must be aware of potential PRES-related Pregabalin toxicity especially when increasing its doses in patients presenting worsening of renal function and in association with opioids.