Cough headache as a presenting feature of posterior reversible encephalopathy syndrome (PRES)

A 23-year-old man with chronic renal failure on maintenance haemodialysis was referred to the neurology outpatient clinic with new onset cough headache. On evaluation, his blood pressure was 220/120 mmHg and outpatient fundus photography showed grade IV hypertensive retinopathy. Urgent magnetic resonance imaging showed features of posterior reversible encephalopathy syndrome (PRES). Emergent treatment of hypertension led to a rapid resolution of his cough headache. New onset cough headache may be a marker of PRES.