Posterior reversible encephalopathy syndrome
Acute confusion and headache. History of recent cesarean section.
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Bilateral symmetrical altered signal intensity of the subcortical white matter of occipital, parietal, posterior temporal and extending to the frontal lobes. they display bright signal on T2 and FLAIR, low T1 signal, no restriction of diffusion on DWI yet there is T2 shine through effect and no significant enhancement on post contrast scan. No significant mass effect.
The clinical history and MR findings are classic for PRES which can involve the anterior circulation as well making it misnomer. The patient received steroids and responded well.