Posterior Reversible Encephalopathy Syndrome Caused by Renovascular Hypertension in a Solitary Functioning Kidney: Successful Treatment With Renal Artery Stenting

Posterior reversible encephalopathy syndrome (PRES) can develop in the setting of severe hypertension and may present with seizures and altered consciousness. We report the case of an 81-year-old woman who presented with impaired consciousness and generalized seizures during a hypertensive crisis. Brain magnetic resonance imaging revealed bilateral parieto-occipital subcortical hyperintensities. Diagnostic imaging revealed severe proximal stenosis of the right renal artery, complete occlusion of the left renal artery, and marked atrophy of the left kidney, suggesting renovascular hypertension due to renal artery stenosis in a solitary functioning kidney. Based on these findings, PRES secondary to renovascular hypertension was diagnosed, and percutaneous renal angioplasty was performed, resulting in stabilization of blood pressure and resolution of neurological symptoms. This case highlights the importance of considering renovascular hypertension as a reversible cause of PRES, especially in patients with a solitary kidney and marked blood pressure elevation and variability.