Posterior reversible encephalopathy syndrome (PRES)

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain

Presentation

New onset of seizures in a patient with pre-eclampsia. The patient is post-emergency cesarian section.

Patient Data

Age: 40 years
Gender: Female

Day 2 postpartum

mri
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Axial T2
fat sat
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Axial
FLAIR
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Axial
DWI
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Axial
ADC
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Axial
SWI
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Sagittal
T1
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Sagittal
FLAIR
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Coronal
FLAIR
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Coronal
T2
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Info

There is bilateral occipital, and bilateral posterior parietal (right greater than left) vasogenic edema.

There is asymmetric non-posterior, left frontal, vasogenic edema.

Features are consistent with posterior reversible encephalopathy syndrome (PRES).

Diffusion and SWI are negative excluding acute infarction and intracerebral hemorrhage.

The pituitary gland is markedly enlarged and consistent with the postpartum state. It measured 11.1 x 10.7 x 18.4 mm (AP x CC X width).

Contrast was not administered.

Case Discussion

Typical features of PRES in a patient with pre-eclampsia, who underwent emergency cesarian section and developed seizures (eclampsia) on day 2 postpartum.

The pituitary gland is dramatically increased in size and volume, however likely normal for the postpartum state and can be reassessed on an elective follow-up MRI scan, especially if there is a clinical concern for a pituitary macroadenoma.

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