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

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.

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.