Posterior reversible encephalopathy syndrome (PRES)

Case contributed by A.Prof Frank Gaillard

Presentation

Renal transplant px (1999). Presented with seizures in the context of 2 weeks of headache and labile BP. - Admitted to ICU for sedation and aggressive BP management

Patient Data

Age: 55
Gender: Female

 

Prominent areas of high T2/FLAIR signal within the subcortical white matter of both occipital lobes. Smaller, patchy areas of high T2/FLAIR signal in the centrum semiovale/corona radiation are also noted.

No intra- or extra-axial collection or mass. In the left mesial temporal there is high DWI with corresponding low ADC signal (not shown). No evidence of previous infarction or haemorrhage. 

Medially projecting 3 x 2.5mm left carotid cave ICA aneurysm MRA otherwise unremarkable, with no stenosis or focal abnormality identified. No abnormal signal noted on the MRV.

Conclusion:

Subcortical occipital lobe T2 hyperintensity in setting of no restricted diffusion is most in keeping with PRES, particularly in the context of hypertension. Follow up MRI could be performed to ensure resolution. Mesial temporal lobe diffusion restriction is likely post-ictal. Incidental left carotid cave ICA aneurysm.

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Case information

rID: 28241
Case created: 16th Mar 2014
Last edited: 28th Oct 2015
Inclusion in quiz mode: Included

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