This patient was admitted to hospital which confirmed severe hypertension, she received antihypertensive drugs with subsequent improvement of her mental status.

This case illustrates the importance of Susceptibility-Weighted Imaging in the detection of parenchymal micro-hemorrhage in the setting of PRES syndrome, which would help to increase diagnostic accuracy.

A.M. McKinney et al, described the importance of SWI in the detection of micro-hemorrhagic foci in PRES syndrome. They demonstrated in their case study that SWI showed a higher rate of micro-hemorrhagic foci than previously described. They also suggested that those micro-hemorrhagic foci are not correlated with the patient's clinical severity, the MRI imaging severity/extent of edema for PRES syndrome, the presence of DWI-positive findings, or the presence of enhancement on T1WI. Additionally, most micro-hemorrhagic foci appear to persist on long-term follow-up.

They presumed that those micro-hemorrhagic foci could be attributed to o endothelial cell dysfunction.

Small artery disease with bilateral centrum semiovale chronic ischmic foci.

Diffuse brain atrophic changes.

• Based on the radiological findings mainly the posterior distribution, the gyral subtle diffusion restriction and importantly the multiple parenchymal micro-hemorrhagic foci; posterior reversible encephalopathy syndrome (PRES) was considered.