Posterior reversible encephalopathy syndrome

Case contributed by Dr Ian Bickle


Young male with 2 day history of profound headache. No focal neurology. BP 230/110 mmHg.

Patient Data

Age: 40
Gender: Male

ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with 

Modality: CT

Low attenuatuion in the posterior periventricular white matter, which is symmetrical in nature.

No haemorrhage or infarction.

Modality: MRI

Periventricular, largely posteriorly located high T2 signal in a symmetrical fashion.

The DWI/ADC maps show increased diffusion.

SWI shows haemosiderin products in keeping with old mircohaemorrhages of hypertension.

Case Discussion

Cross section imaging findings classical of PRES - with an appropriate associated clinical history.

Posterior reversible encephalopathy syndrome (PRES) (also known as hypertensive encephalopathy) is a neurotoxic state occurring secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. Hyperperfusion with resultant disruption of the blood brain barrier results in vasogenic oedema, most commonly in the parieto-occipital regions.

The blood product sensitive sequences show evidence of hypertensive microangiopathy, indicating an acute on chronic problem with blood pressure.

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Case Information

rID: 30870
Case created: 7th Sep 2014
Last edited: 29th Feb 2016
Inclusion in quiz mode: Included

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