# Posterior Reversible Encephalopathy Syndrome in a Patient With Intrahepatic Cholangiocarcinoma: Converging Effects of Acute Hypertension and Cisplatin Therapy

## TL;DR

A cancer patient developed a rare brain condition due to high blood pressure and chemotherapy, showing the importance of considering this condition in cancer patients with neurological symptoms.

## Contribution

This case highlights the combined effects of acute hypertension and cisplatin in causing PRES in an oncology patient.

## Key findings

- PRES was diagnosed in a patient with intrahepatic cholangiocarcinoma receiving cisplatin.
- The patient showed improvement with blood pressure control and antiepileptic therapy.
- The case emphasizes the need for expanded differential diagnoses in oncology patients with neurological symptoms.

## Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state characterized by seizures, headache, altered mental status, and characteristic posterior-predominant vasogenic edema on neuroimaging. It is frequently associated with acute hypertension, endothelial dysfunction, and exposure to cytotoxic or immunosuppressive agents. We report a case of PRES in a patient with stage IIIB intrahepatic cholangiocarcinoma receiving cisplatin-based chemotherapy who presented with new-onset generalized tonic-clonic seizures in the setting of newly diagnosed acute hypertension. Magnetic resonance imaging demonstrated posterior-predominant subcortical fluid-attenuated inversion recovery (FLAIR) hyperintensities consistent with PRES. The patient improved with strict blood pressure control, antiepileptic therapy, and supportive care. This case illustrates the contribution of coexisting risk factors, including acute hypertension and cisplatin exposure, to the development of PRES. It also highlights the need for broadened differential diagnoses, particularly in oncology patients in whom neurologic symptoms may initially be attributed to alternative etiologies.