An Unusual PRESentation of Stroke

We describe the case of a 55-year-old woman with well controlled HIV presenting with visual disturbance following a generalised tonic-clonic seizure and headache. She was diagnosed with posterior reversible encephalopathy syndrome (PRES), complicated by infarction. Her blood pressure was raised during admission, but she was not previously known to be hypertensive. We discuss that HIV, even with an undetectable viral load, is an independent risk factor for PRES due to endothelial dysfunction, arising from altered immune system function. Hypertension is a common risk factor for PRES but may also arise as an autoregulatory consequence of end organ hypoperfusion. Ischaemia and haemorrhage are rare complications of PRES, but they account for much of the morbidity associated with this condition.