Objective: Our aim is to report a case of unusual manifestation of atypical posterior reversible encephalopathy syndrome (PRES), which showed periodic lower limb movements and malignant hypertension initially.
Background: Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic and a clinico-radiological syndrome characterized by a spectrum neurological and radiological feature from various risk factors. Common neurological symptoms include headache, impairment in level of consciousness, seizures, visual disturbances, and focal neurologic deficits. A PRES initially presenting with symptoms of movement disorders is extremely rare, and asymmetric periodic lower limb movements combined with malignant hypertension without previous medical history have not been described.
Method: Single case report.
Results: A 41-year-old man referred to us at ER due to involuntary movement symptoms of leg and foot. His medical and neurological examination revealed not only asymmetric periodic lower limb movements as like periodic limb movements in sleep (PLMS), but also malignant hypertension, mild blurred vision and headache. Brain magnetic resonance image (MRI) show high signal lesions in the pons, medulla and cerebellum, and so he was diagnosed as PRES. After successful blood pressure control and ICU medical treatment, asymmetric periodic lower limb movement symptoms fully recovered and brain MRI neuroimaging studies also improved markedly.
Conclusion: For now, we report for the first time a rare initial manifestation of atypical PRES presenting asymmetric periodic lower limb movements. As like this case, if there are asymmetric periodic lower limb movements combined with malignant hypertension, it should be considered clinical diagnosis of PRES for emergent medical and neurological treatments.
To cite this abstract in AMA style:
W. Yoon. Asymmetric periodic lower limb movements and malignant hypertension as an initial manifestation of atypical posterior reversible encephalopathy syndrome (PRES) [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/asymmetric-periodic-lower-limb-movements-and-malignant-hypertension-as-an-initial-manifestation-of-atypical-posterior-reversible-encephalopathy-syndrome-pres/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/asymmetric-periodic-lower-limb-movements-and-malignant-hypertension-as-an-initial-manifestation-of-atypical-posterior-reversible-encephalopathy-syndrome-pres/