Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Atypical Unilateral Posterior Reversible Encephalopathy Syndrome Mimicking a Middle Cerebral Artery Infarction

  • Camlidag, Ilkay (Department of Radiology, Ondokuz Mayis University, Faculty of Medicine) ;
  • Cho, Yang-Je (Department of Neurology, Yonsei University Severance Hospital) ;
  • Park, Mina (Department of Radiology, Yonsei University Severance Hospital) ;
  • Lee, Seung Koo (Department of Radiology, Yonsei University Severance Hospital)
  • Received : 2014.11.14
  • Accepted : 2015.05.22
  • Published : 2015.09.01
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Abstract

Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.

Keywords

References

  1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500 https://doi.org/10.1056/NEJM199602223340803
  2. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 2008;29:1036-1042 https://doi.org/10.3174/ajnr.A0928
  3. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007;189:904-912 https://doi.org/10.2214/AJR.07.2024
  4. McKinney AM, Jagadeesan BD, Truwit CL. Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema. AJR Am J Roentgenol 2013;201:631-638 https://doi.org/10.2214/AJR.12.9677
  5. Hugonnet E, Da Ines D, Boby H, Claise B, Petitcolin V, Lannareix V, et al. Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagn Interv Imaging 2013;94:45-52 https://doi.org/10.1016/j.diii.2012.02.005
  6. Schambra HM, Greer DM. Asymmetric reversible posterior leukoencephalopathy syndrome. Neurocrit Care 2006;4:245-247 https://doi.org/10.1385/NCC:4:3:245
  7. Covarrubias DJ, Luetmer PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol 2002;23:1038-1048
  8. Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 2009;30:1371-1379 https://doi.org/10.3174/ajnr.A1588
  9. McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012;33:896-903 https://doi.org/10.3174/ajnr.A2886
  10. Dhar R, Dacey R, Human T, Zipfel G. Unilateral posterior reversible encephalopathy syndrome with hypertensive therapy of contralateral vasospasm: case report. Neurosurgery 2011;69:E1176-E1181; E1181
  11. Voetsch B, Tarlov N, Nguyen TN, DeFusco C, Barest GD, Norbash A, et al. Asymmetric posterior reversible encephalopathy syndrome complicating hemodynamic augmentation for subarachnoid hemorrhage-associated cerebral vasospasm. Neurocrit Care 2011;15:542-546 https://doi.org/10.1007/s12028-011-9635-3
  12. Romano A, Silvia P, Alberto P, Tavanti F, Sette G, La Starza S, et al. Asymmetric posterior reversible encephalopathy syndrome in patient with hyperplastic anterior choroidal artery. J Headache Pain 2011;12:259-261 https://doi.org/10.1007/s10194-010-0284-2

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