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Case 2-2025: A 21-Year-Old Man with Loss of Consciousness and a FalL

Article Number: SIS048925AI050525
5th May, 2025
Author(s):
Eric F. Shappell, Brooks P. Applewhite, Sharl S. Azar, David J. Li
Abstract:

A 21-year-old man with sickle cell disease presented with loss of consciousness and a fall, followed by a witnessed tonic-clonic seizure. Initial evaluation revealed hypertension, anemia, and elevated lactate and D-dimer levels. MRI showed vasogenic edema in posterior brain regions, consistent with posterior reversible encephalopathy syndrome (PRES), and chronic microhemorrhages suggestive of prior cerebral fat embolism. The patient underwent red-cell exchange to reduce hemoglobin S levels and was started on levetiracetam for seizure control. Follow-up imaging confirmed resolution of PRES-related edema. The case highlights PRES as a neurologic complication of sickle cell vaso-occlusive crisis and underscores the diagnostic challenges in distinguishing it from stroke or fat embolism syndrome.

Keywords:
Posterior reversible encephalopathy syndrome Sickle cell disease Seizure Vaso-occlusive crisis Cerebral fat embolism MRI Red-cell exchange Hypertension Microhemorrhages Neurologic complications.
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