{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T05:52:54Z","timestamp":1771653174504,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,9]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>Serotonin syndrome (SS) is a drug-induced clinical syndrome, characterised by a triad of cognitive impairment, autonomic hyperactivity and neuromuscular abnormalities. Hypertension, one of the common autonomic manifestations in SS, may lead to lead to several life-threatening conditions. Herein, we report a case of SS who had posterior reversible encephalopathy syndrome (PRES) because of high blood pressure.<\/jats:p>\n               <jats:p>A young male with a 5-month history of chronic tension-type headache and depression had been receiving amitriptyline and paroxetine. Increment of paroxetine led to the development of various new clinical features, fulfilling the Hunter criteria of SS. MRI brain revealed high-signal intensity lesions on T2 fluid-attenuated inversion recovery, and T2-weighted imaging in the posterior regions of the occipital, parietal, temporal and cerebellum lobes, suggestive of PRES. The patient responded to cyproheptadine. Autonomic hyperactivity, due to SS, is the most likely explanation of this association.<\/jats:p>","DOI":"10.1136\/bcr-2020-236450","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T14:29:46Z","timestamp":1607524186000},"page":"e236450","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Posterior reversible encephalopathy syndrome in a patient with serotonin syndrome"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7322-904X","authenticated-orcid":false,"given":"Sanjay","family":"Prakash","sequence":"first","affiliation":[{"name":"Neurology, Smt BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Waghodia, Gujarat, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaturbhuj","family":"Rathore","sequence":"additional","affiliation":[{"name":"Smt BK Shah Medical Institute and Research Centre, Vadodara, Gujarat, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana","family":"Kaushikkumar","sequence":"additional","affiliation":[{"name":"Neurology, Smt BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Waghodia, Gujarat, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"2025082711514120000_13.12.e236450.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra041867"},{"key":"2025082711514120000_13.12.e236450.2","doi-asserted-by":"publisher","DOI":"10.1136\/ejhpharm-2018-001752"},{"key":"2025082711514120000_13.12.e236450.3","doi-asserted-by":"crossref","first-page":"204512531881881","DOI":"10.1177\/2045125318818814","article-title":"Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques","volume":"9","author":"Ott","year":"2019","journal-title":"Ther Adv Psychopharmacol"},{"key":"2025082711514120000_13.12.e236450.4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1159\/000505907","article-title":"Serotonin syndrome presenting as a posterior reversible encephalopathy syndrome","volume":"12","author":"Malik","year":"2020","journal-title":"Case Rep Neurol"},{"key":"2025082711514120000_13.12.e236450.5","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcg109"},{"key":"2025082711514120000_13.12.e236450.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00111-8"},{"key":"2025082711514120000_13.12.e236450.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602223340803"},{"key":"2025082711514120000_13.12.e236450.8","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00071"},{"key":"2025082711514120000_13.12.e236450.9","doi-asserted-by":"crossref","DOI":"10.4103\/0028-3886.241364","article-title":"Posterior reversible encephalopathy syndrome in eclampsia","volume":"66","author":"Garg","year":"2018","journal-title":"Neurol India"},{"key":"2025082711514120000_13.12.e236450.10","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2019.01420","article-title":"Posterior reversible encephalopathy syndrome in clinical toxicology: a systematic review of published case reports","volume":"10","author":"Largeau","year":"2019","journal-title":"Front Neurol"},{"key":"2025082711514120000_13.12.e236450.11","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-234184","article-title":"Guillain-Barr\u00e9 syndrome and posterior reversible leukoencephalopathy syndrome: a rare association","volume":"13","author":"Joshi","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2025082711514120000_13.12.e236450.12","doi-asserted-by":"crossref","first-page":"52","DOI":"10.4103\/aian.AIAN_344_18","article-title":"Refining the clinical features of serotonin syndrome: a prospective observational study of 45 patients","volume":"22","author":"Prakash","year":"2019","journal-title":"Ann Indian Acad Neurol"},{"key":"2025082711514120000_13.12.e236450.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-016-0616-1","article-title":"Conundrums in neurology: diagnosing serotonin syndrome\u2014a meta-analysis of cases","volume":"16","author":"Werneke","year":"2016","journal-title":"BMC Neurol"},{"key":"2025082711514120000_13.12.e236450.14","doi-asserted-by":"crossref","unstructured":"Prakash S , Rathore C , Rana K . 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