# A Case of Vasculitic Neuropathy Presenting With Progressive Sensory-Motor Limb Involvement, Posterior Reversible Encephalopathy Syndrome, and Systemic Symptoms in a 70-Year-Old Woman

## TL;DR

A 70-year-old woman with progressive nerve issues and brain syndrome was diagnosed with vasculitis, showing how complex such cases can be and the importance of biopsies and timely treatment.

## Contribution

Highlights the role of biopsy in diagnosing vasculitis with central and peripheral nervous system involvement when non-invasive tests fail.

## Key findings

- Vasculitic neuropathy was confirmed via nerve biopsy despite negative PET scan results.
- Aggressive treatment with corticosteroids and blood pressure control reversed PRES and improved neurological function.
- The case emphasizes the diagnostic challenge of systemic vasculitis with multi-system involvement.

## Abstract

We present the case of a 70-year-old woman with progressive weakness and altered sensation in her hands and feet, complicated by intermittent confusion, status epilepticus, and posterior reversible encephalopathy syndrome (PRES). She was known to have cervical spinal stenosis and gave a vague history of an autoimmune disorder, which was in remission for the past many years. Extensive evaluation for infectious, compressive, and paraneoplastic causes was unrevealing. Investigations revealed severe axonal peripheral neuropathy with active vasculitic features confirmed on nerve biopsy, which were not picked up by the PET scan. With aggressive blood pressure control and high-dose corticosteroids, PRES resolved radiologically, and neurological function improved gradually. This case highlights the diagnostic complexity of systemic vasculitis presenting with simultaneous central and peripheral nervous system involvement, underscores the indispensable role of biopsy when non-invasive tests are inconclusive, and illustrates how timely immunosuppression and hemodynamic control can reverse central manifestations while stabilizing peripheral nerve injury.