Presentation
Acute confusion with decreased level of consciousness and high blood pressure 12 hours following delivery.
Patient Data
Bilateral cortical and subcortical white matter hypoattenuating areas of the occipital, posterior temporal and parietal lobes extending to the frontal lobes with no hemorrhagic component or enhancement.
The cerebral venous sinuses are patent.
Case Discussion
The clinical presentation and the CT features are highly suggestive of posterior reversible encephalopathy syndrome (PRES).
Posterior reversible encephalopathy syndrome occurs due to an abnormal sympathetic innervation of the posterior circulation which results in inability to control acute rise in blood pressure. Its pathology is related to vasogenic edema of occipital and posterior parietal region (posterior circulation territory). It is associated with several conditions e.g. severse hypertension, SLE, HUS, drug toxicity and following stem cell transplantation.