Reports of different types of
neurological manifestations of
COVID-19 are rapidly increasing, including changes of posterior reversible
leukoencephalopathy syndrome (PRES). Here we describe the first reported case of
COVID-19 and PRES in Australia diagnosed on basis of MRI brain imaging and confirmed clinically by presence of
confusion,
delirium,
headaches, also associated with
hypertension and blood pressure variability and stable long-term kidney problems. He made full recovery as his blood pressure was controlled and clinical status was supported with appropriate supportive
therapy. Although traditionally a rare condition, PRES is likely to be more common among patients with
COVID-19 pathobiology there is
Renin downregulation of ACE2 receptors, involvement of Renin-Angiotensin-Aldosterone system, endotheliitis,
cytokine storm, and hyper-immune response. Thus we advocate clinical suspicion and early brain imaging with MRI brain among vulnerable patients with known co-morbidities, and diagnosed with
COVID-19 given that
hypertension and blood pressure variability are often exacerbated by acute SARS-CoV-2 immune reactions. Such acute
hypertensive encephalopathy was able to be reversed with timely supportive
therapy ensuring re-hydration and re-establishment of blood pressure control.