IndexAbstractIntroductionConclusionAbstractPosterior reversible encephalopathy syndrome (PRES) is a clinical neuroradiological entity characterized by variable associations of neurological symptoms. Brain abnormalities are often symmetrical and predominate in the posterior white matter. PRES can develop in association with many conditions including hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressive drugs. Only a few cases in the literature show an association between PRES and acute pancreatitis. We report the case of a 61-year-old woman who presented with PRES after pancreatitis related to endoscopic retrograde cholangiopancreatography. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay IntroductionPosterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity first described by Hinchey et al. in 1996 it was increasingly recognized and reported in case reports but the real incidence is not known [2]. Patients of all ages appear susceptible and case series suggest that it is more common in women[3,4]. PRES is characterized by variable associations of seizure activity, impaired consciousness, headache, visual abnormalities and focal neurological signs[5]. Typical magnetic resonance imaging (MRI) findings are symmetric white matter edema in the posterior hemispheres, particularly in the parieto-occipital regions[6-9]. Both clinical and radiological features are generally reversible once the cause is removed. PRES occurs most often in the setting of hypertensive crisis, eclampsia, cytotoxic or immunosuppressive therapy, and renal disease[10-13]. Regardless of the underlying cause, the main abnormality is cerebral vasogenic edema [14]. Only a few cases in the literature show an association between PRES and acute pancreatitis[15-23]. Clinical case: A 61-year-old Caucasian woman, who came to our attention from the emergency room, complained of abdominal pain that had lasted for 5 days. She reported having undergone cholecystectomy and appendectomy in the past and denied a history of hypertension. The remaining medical history was unremarkable. Blood samples showed an increase in total bilirubin (2.1 mg/dl), gamma-glutamyl transpeptidase (1105U/l) and alkaline phosphatase (615U/l); inflammatory indices, serum amylase and lipase levels were within the normal range. An ultrasound of the abdomen was performed: mild dilatation of the main bile duct was found without evidence of stones; there was also dilation of the intrahepatic bile ducts. Therefore, the patient was admitted to the HPB unit of our hospital where she underwent ERCP (Endoscopic Retrograde CholangioPancreatography). This examination highlighted an inflamed papilla, causing a sub-stenosis of 1 cm. Sphincterotomy of Oddi and brushing of the inflammatory lesion were performed (cytology was negative for malignant tumor cells). A 10 Fr plastic biliary stent was placed. 3 hours after the procedure, the patient developed post-ERCP pancreatitis, with increased serum amylase (3262U/l) and lipase (3963U/l); The leukocyte count was 12.6 mg/dl. He also complained of rebound abdominal pain, responsive to pain relief with NSAIDs. The morning after surgery the patient was in good general condition with less abdominal pain. In the afternoon the patient experienced the sudden onset of complete bilateral blindness. Vital signs were normal except for mild hypertension (160/80). On neurological examination the pupillary response to light was intact and no others were detected.