This report presents a case of a 71-year-old woman with
Fisher syndrome who had
posterior reversible encephalopathy syndrome (PRES) before the initiation of
intravenous immunoglobulin (
IVIg) treatment. She had symptoms of
common cold 2 weeks before the onset of PRES. On the day of the onset, she began to stagger while walking. On day 2, she developed
hypertension, vision impairment, and limb weakness and was admitted to the hospital. On day 3, she was provided
steroid pulse
therapy. On day 4, she developed convulsions and right imperfection single
paralysis and was transferred to the our hospital. During the transfer, the patient was conscious. Her blood pressure was high at 198/107 mmHg. She had mild weakness in her limbs and face, light perception in both eyes, dilation of both pupils, total
external ophthalmoplegia, no tendon reflexes, and limb and trunk
ataxia. We diagnosed PRES because of the high signal intensities observed on T2-weighted MRI on both sides of the parietal and occipital lobes. We also diagnosed
Fisher syndrome because of a positive anti-GQ1b
immunoglobulin G antibody test and albuminocytologic dissociation in the cerebrospinal fluid. PRES showed prompt improvement with
antihypertensive therapy, whereas
Fisher syndrome slowly improved over a course of 2 months. This case is the first report of PRES without
IVIg suggesting that
Fisher syndrome induces
hypertension and causes PRES.