Posterior reversible encephalopathy syndrome (PRES)

Case contributed by Dr Bruno Di Muzio

Presentation

Patient on day 20 post bone marrow transplant. Headaches and hypertension. Now decreased GCS. Intracranial bleeding?

Patient Data

Age: 60 years
Gender: Female

No intracranial haemorrhage. There are areas of ill-defined hypoattenuation involving predominantly the subcortical white-matter in both parietal and occipital lobes. The remainder of the brain parenchyma is preserved. Ventricular system and cisternal spaces appear normal. The visualised orbits, paranasal sinuses, and calvaria appear unremarkable. 

The previously demonstrated abnormalities involving predominantly the subcortical white-matter in both parietal and occipital lobes in relatively symmetrical fashion corresponds to increased T2/FLAIR signal, but no diffusion restriction. Apart from a few white matter likely chronic small vessels changes, the brain has otherwise normal appearances. No abnormal contrast enhancement noted. The ventricles and basal cisterns are normal. No signs of intracranial haemorrhage. MRA of the circle of Willis arteries is unremarkable, with no signs of high-grade stenosis or vascular malformations. 

MRI

MRI 5 weeks later

Single axial FLAIR 5 weeks later demonstrates complete resolution of the occipital changes. 

Case Discussion

This case illustrates the classical distribution and appearances for posterior reversible encephalopathy syndrome (PRES), which has drug toxicity among the possible aetiological causes. 

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Case information

rID: 55441
Case created: 6th Sep 2017
Last edited: 9th Oct 2017
Inclusion in quiz mode: Included

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