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.

• Alsoalso cerebral amyloid angiopathy-related inflammation was another possibility secondary to the patient's age, the asymmetric lesion and multiple microbleeds

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 (SWI) in the detection of parenchymal micro-hemorrhagemicrohemorrhage in the setting of PRES, which would help to increase diagnostic accuracy.

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

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

Right parieto-occipital subcortical white matter abnormal signal eliciting high signal on T2 &and FLAIR WI. Corresponding subtle gyral diffusion restriction is noted, yet with no significant post contrast enhancement.  On On SWI, there are corresponding parenchymal multiple innumerable micro-hemorrhagicmicrohemorrhagic foci. Similar patches of abnormal signal are seen at the right thalamic pulvinar and the pons.

Small artery disease with bilateral centrum semiovale chronic ischaemic foci.

Diffuse brain atrophic changes.

• Basedbased on the radiological findings mainly the posterior distribution, the gyral subtle diffusion restriction and importantly the multiple parenchymal micro-hemorrhagicmicrohemorrhagic foci; posterior reversible encephalopathy syndrome (PRES) was considered.
• Alsoalso cerebral amyloid angiopathy-related inflammation was another possibility secondary to the patient's age, the asymmetric lesion and multiple microbleeds.