Posterior reversible encephalopathy syndrome (PRES)

Case contributed by Tamsir Rongpipi


Severe headache, altered mental state and high blood pressure.

Patient Data

Age: 30 years
Gender: Female

T2/ FLAIR fairly symmetrical high signal intensities in both subcortical regions of occipital lobes without diffusion restriction in DWI. No signal loss is seen in SWAN sequences.

There are irregularity of the anterior, middle and posterior cerebral arteries with multifocal segments of vasospasm, giving the "string-of-beads" appearance seen in MRA.

Case Discussion

The imaging features are consistent with Posterior reversible encephalopathy syndrome (PRES). PRES is a neurotoxic state in setting of number of complex conditions like preeclampsia/eclampsia, allogeneic bone marrow transplantation, organ transplantation, autoimmune disease and high dose chemotherapy.

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