Posterior reversible encephalopathy syndrome (PRES)
Seizures in the setting of recent bone marrow transplantation.
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There are T2 high signal lesions within the cortex and subcortical region of both parietal and occipital lobes. There is associated gyral swelling. There is also involvement of the left posterior temporal lobe and the cortex of the pre-and post central gyri bilaterally.
No associated restricted diffusion. No susceptibility artefact to indicate underlying haemorrhage. No underlying lesions.
The appearances favour posterior reversible encephalopathy syndrome (PRES) either directly related to bone marrow transplantation or one of many drugs.
While first described in the setting of eclampsia and hypertension, it is also well documented in the setting of post-transplantation immunosuppresion and cyclosporin.
- de Groen PC, Aksamit AJ, Rakela J, et al. Central nervous system toxicity after liver transplantation: the role of cyclosporine and cholesterol. N Engl J Med 1987;317:861–66
- Ghalie R, Fitzsimmons WE, Bennett D, et al. Cortical blindness: a rare complication of cyclosporine therapy. Bone Marrow Transplant 1990;6:147–49