Presentation
Patient with a history of LES and lupus nephritis. She has been hospitalized a month ago for lupus-related symptoms and has received immunosuppressive therapy. Symptoms: Headaches, altered mental status, and focal neurological deficits. BP: 180/90
Patient Data
At the supratentorial level, multiple lesions are observed that exclusively affect the white matter, predominantly in the occipital and parietal lobes. These lesions have well-defined borders, behaving hypointense on T1, and hyperintense on T2/FLAIR with respect to the gray matter, without presenting magnetic susceptibility artifact on HEMO sequence and without diffusion sequence restriction or enhancement upon administration of contrast medium paramagnetic.
Case Discussion
PRES primarily involves the white matter of the brain, commonly in the posterior regions; this condition is associated with increases in blood pressure, kidney dysfunction, certain medications, autoimmune disorders, and other medical conditions.
The pathophysiology involves impaired autoregulation of cerebral blood flow and endothelial dysfunction. These factors can lead to the disruption of the blood-brain barrier and the accumulation of fluid in the brain's white matter, resulting in swelling and damage to the surrounding tissues.
The symptoms of PRES include headaches, seizures, visual disturbances, altered mental status, and focal neurological deficits. These symptoms can develop rapidly over a few hours to days. In some cases can progress to more severe complications, such as cerebral hemorrhage or infarction.
Diagnosis is a combination of clinical evaluation and brain imaging. MRI is considered the preferred imaging modality due to its higher sensitivity for detecting characteristic findings. The MRI characteristic findings include edema and hyperintensities in sequences T2 and FLAIR, usually located at the posterior parietooccipital level.
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