[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-408654-105":59,"doc-detail-408654-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","an-association-between-posterior-reversible-encephalopathy-syndrome-and-severe-hypercapnia-in-chronic-co-retention","An Association Between Posterior Reversible Encephalopathy Syndrome and Severe Hypercapnia in Chronic CO₂ Retention","","A case report analyzes a 60-year-old man with chronic obstructive pulmonary disease (COPD) on home oxygen and chronic CO₂ retention who developed acute encephalopathy after hypoxemic and hypercapnic respiratory failure. Brain MRI showed vasogenic edema in the bilateral occipital lobes, consistent with posterior reversible encephalopathy syndrome (PRES). Escalating supplemental oxygen and nightly BiPAP improved neurological status quickly, and follow-up MRI six days later showed resolving edema. The report frames severe hypercapnia as an uncommon trigger and emphasizes rapid correction of hypercapnia to improve both clinical and radiographic findings.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/an-association-between-posterior-reversible-encephalopathy-syndrome-and-severe-hypercapnia-in-chronic-co-retention/408654/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/an-association-between-posterior-reversible-encephalopathy-syndrome-and-severe-hypercapnia-in-chronic-co-retention/408654.png","ImageObject",300,407,{"name":92,"@type":93},"dawugda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What patient condition preceded the development of PRES in this case?","Question",{"text":113,"@type":114},"The patient had COPD with chronic CO₂ retention and presented with hypoxemic and hypercapnic respiratory failure before developing acute encephalopathy and PRES.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did clinicians document the severity of hypercapnia?",{"text":118,"@type":114},"Arterial blood gas testing showed chronic compensated respiratory acidosis initially, followed by profound hypercapnia with PaCO₂ exceeding 102 mm Hg.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatment led to improvement in both symptoms and MRI findings?",{"text":122,"@type":114},"Increasing supplemental oxygen and nightly bilevel positive airway pressure (BiPAP) rapidly improved neurological status, and a repeat MRI six days later demonstrated improving vasogenic edema.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},408654,1790742716,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Review began 08/25/2025  \nReview ended 11/25/2025  \nPublished 12/01/2025  \n© Copyright 2025  \nYen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98256  \nOpen Access Case Report  \nAn Association Between Posterior Reversible Encephalopathy Syndrome and Severe Hypercapnia in Chronic CO₂ Retention  \nCameron Yen 1, Linda Chun 1, Jay Mahajan 1, 2, Aroucha Vickers 1, 2  \n1. Neurology, Valley Hospital Medical Center, Las Vegas, USA 2. Neurology, Las Vegas Neurology Center, Las Vegas, USA  \nCorresponding author: Cameron Yen, [cameronyen10@gmail.com](cameronyen10@gmail.com)  \nAbstract  \nWe discuss a 60-year-old male with a history of chronic obstructive pulmonary disease (COPD) on home oxygen and chronic carbon dioxide (CO₂) retention who initially presented with hypoxemic and hypercapnic respiratory failure and subsequent development of acute encephalopathy. Magnetic resonance imaging (MRI) of the brain showed vasogenic edema in the bilateral occipital lobes. Management with increasing supplemental oxygen and nightly bilevel positive airway pressure (BiPAP) led to rapid neurological improvement. A repeat brain MRI of the brain six days later showed improving edema in the bilateral occipital lobes. This case highlights acute and severe hypercapnia as a potentially uncommon and underrecognized trigger of PRES. It further underscores that prompt correction of hypercapnia can rapidly improve both clinical and radiographic manifestations of PRES.  \nCategories: Neurology  \nKeywords: acute hypercapnia, acute hypercapnic respiratory failure, copd (chronic obstructive pulmonary disease), hypercapnia, posterior reversible encephalopathy syndrome (pres), severe hypercapnia, vasogenic brain edema  \nIntroduction  \nFirst described by Hinchey et al. in 1996, PRES is a clinicoradiological disorder characterized by the abrupt onset of neurological symptoms and distinctive neuroimaging findings [1] . It presents with nonspecific but characteristic symptoms, including headache, seizures, encephalopathy, or visual disturbances. MRI of the brain most often demonstrates reversible vasogenic edema involving the posterior circulation, specifically the subcortical white matter of the parieto-occipital regions [2] . Although acute hypertension, renal disease, autoimmune disorders, and exposure to immunosuppressive or cytotoxic agents are well-established risk factors, PRES can also arise from other systemic insults [3,4] . Hypercapnia, defined as an arterial partial pressure of carbon dioxide (PaCO₂) > 45 mm Hg, can alter cerebral blood flow by inducing vasodilation and impairing autoregulatory capacity, potentially increasing susceptibility to vasogenic edema [5,6] . Case reports linking severe hypercapnia to PRES remain limited, but the pathophysiologic plausibility is supported by its effects on cerebral hemodynamics [5,6] . We report a case of PRES occurring in a patient with COPD and chronic CO₂ retention, with acute elevations in PaCO₂ as a potential precipitating factor.  \nCase Presentation  \nA 60-year-old male with a history of COPD on 2 liters of home oxygen, chronic CO₂ retention, recurrent aspiration pneumonia, and chronic tobacco use presented with hypoxemic and hypercapnic respiratory failure. At the time of admission, the patient was fully oriented to person, place, time, and situation and able to follow commands with no focal neurological deficits. Arterial blood gas (ABG) revealed a pH of 7.43, PaCO₂ of 75 .8 mm Hg, PaO₂ of 27.7 mm Hg, and bicarbonate of 37.2, consistent with chronic compensated respiratory acidosis. The initially reported PaO₂ was likely a sampling error, as it was incompatible with the patient’s clinical status. Nevertheless, a repeat ABG performed shortly thereafter showed a pH of 7.43, a PaCO₂ of","cbCaio3MBss6OUPH","https://ap.wps.com/l/cbCaio3MBss6OUPH","pdf",1293590,"English","# Abstract\n# Introduction\n# Case Presentation\n## Initial presentation and diagnostics\n## Treatment course and neurological deterioration\n## Imaging findings and diagnosis","[{\"question\":\"What patient condition preceded the development of PRES in this case?\",\"answer\":\"The patient had COPD with chronic CO₂ retention and presented with hypoxemic and hypercapnic respiratory failure before developing acute encephalopathy and PRES.\"},{\"question\":\"How did clinicians document the severity of hypercapnia?\",\"answer\":\"Arterial blood gas testing showed chronic compensated respiratory acidosis initially, followed by profound hypercapnia with PaCO₂ exceeding 102 mm Hg.\"},{\"question\":\"What treatment led to improvement in both symptoms and MRI findings?\",\"answer\":\"Increasing supplemental oxygen and nightly bilevel positive airway pressure (BiPAP) rapidly improved neurological status, and a repeat MRI six days later demonstrated improving vasogenic edema.\"}]","An Association Between Posterior Reversible Encephalopathy Syndrome and Severe Hypercapnia in Chronic CO₂ Retention | PDF",1790580115,13]