Posterior reversible encephalopathy syndrome

Case contributed by Dr Ian Bickle

Presentation

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

Patient Data

Age: 40 years
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 Radiopaedia.org. 

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

No hemorrhage or infarction.

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

The DWI/ADC maps show increased diffusion.

SWI shows hemosiderin 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 edema, 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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