Clinical History
62-year-old lady presented with one day history of dizziness and
elevated blood pressure. She had history of chronic renal failure
and diabetes mellitus. After hospital admission, she developed status
epilepticus.
Diagnosis:
Posterior reversible encephalopathy syndrome
Comment :
MRI (T1W, T2W, FLAIR, DWI) showed multiple cortical and
subcortically lesions in bilateral cerebellar hemispheres, left
side of pons, bilateral thalami and bilateral insular regions, left
para-hippocampus and bilateral cerebral cortex. They predominantly
distribute over the cerebellum and occipital region. They are hypointense
on T1WI images and hyperintense on T2WI and FLAIR images and showed
restricted diffusion on diffusion-weighted study. There was mild
mass effect and no contrast enhancement.
The distribution of lesions in posterior reversible encephalopathy
syndrome (PRES) is almost always bilateral and rather symmetrical.
They involve primarily the white matter, but cortex is also involved.
Typical site involves posterior portions of both cerebral hemispheres,
especially the parieto-occipital regions. Other posterior structures,
such as cerebellum and brainstem, are also commonly affected. Involvement
of the deep gray nuclei can also occur. Contrast enhancement is
variable. Although the lesions predominate in posterior circulation
territories, lesions of the anterior circulation are also seen.
Anterior abnormalities tend to be seen only in the most severe cases
and are usually associated with edema in the posterior circulation
territories.
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