Presentation
Abnormal body movements and decreased mentation persisting for 20 hours.
Patient Data
There is diffuse bilateral vasogenic edema of brain parenchyma involving the occipital, parietal, frontal lobes, and part of the temporal lobe. The basal cistern, fissures, and sulci are symmetrically effaced. There is no hyperdense vessel sign in the dural sinuses, and no intracranial hemorrhage is observed. These findings are suggestive of PRES with signs of increased intracranial pressure (ICP).
After 24 hours of PRES management, an MRI was performed and showed T1 hypointense, and T2 hyperintense "finger-like" lesions with high signal on FLAIR images involving bilateral occipital, parietal, and part of frontal lobes. The lesions show no significant diffusion restriction on DWI/ADC mapping. There are also a few patchy cortical post-contrast enhancements and a beaded or string of pearls appearance of the right PCA, likely indicating vasospasm.
On time-of-flight images, MR venography, and MR angiography, no filling defects or aneurysms were observed.
Case Discussion
In the presence of adequate clinical data:
A known pre-eclampsia patient gave birth 24 hours ago via spontaneous vaginal delivery.
The presentation includes abnormal body movement, headache, and decreased mentation.
Her CBC profile is within the normal range on follow-up, including WBC 10,800, Hb 11.5 mg/dL, platelet count 231,000 cells/µL, and serum Cr is normal.
Imaging findings on both CT and MRI shows diffuse bilateral vasogenic edema involving the occipital and parietal lobes, and parts of the frontal and lateral temporal lobes likely in the watershed area without diffusion restriction. There are a few patchy areas of enhancement and a "string of pearls" appearance of the right PCA. These findings highly suggest posterior reversible encephalopathy syndrome (PRES).
Considering PRES, management was started immediately, and the patient is clinically improving.
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