A Rare Case of Hypertensive Chorioretinopathy with Posterior Reversible Encephalopathy Syndrome (PRES) in a Teenage Girl

Abstract

Hypertensive chorioretinopathy is a rare eye manifestation due to acute elevation in blood pressure. In this case, we reported a young hypertensive patient who presented with hypertensive chorioretinopathy and posterior reversible encephalopathy syndrome (PRES). The purpose of this case report is to raise awareness among clinicians to identify, aggressively treat and monitor paediatric patients with hypertension to prevent life and vision-threatening complications. A 14-year-old Malay girl with a history of uncontrolled hypertension and end-stage renal failure presented with the sudden onset of a generalised tonic-clonic seizure preceded by a headache for two days. There was a progressive blurring of vision in both eyes for four months before the presentation. Visual acuity over the right eye was counting fingers (CF) and hand movement (HM) in the left eye. Both fundi revealed features of hypertensive chorioretinopathy with Elschnig spots and Siegrist streaks. Systemic blood pressure during presentation was 235/152 mmHg. A computed tomography (CT) scan of the brain suggestive features of PRES. Six weeks later, with controlled hypertension, her visual acuity improved to 6/60 in both eyes. Hypertensive chorioretinopathy is usually the sign of an acute, dramatic increase in systemic blood pressure in a young person. Achievement of target blood pressure is important to prevent vision-threatening and neurological complication.