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Atypical MRI presentation of posterior reversible encephalopathy syndrome with predominant brainstem involvement

  • Benjamin HebantEmail author
  • Evelyne Guegan-Massardier
  • Aude Triquenot-Bagan
  • Ozlem Ozkul-Wermester
Neuro-Images
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Abstract

We report here the case of a 80-year-old woman for the assessment of an acute confusional state since 2 days asssociated with diffuse and gradual headache. Brain MRI disclosed isolated hyperintense signal on fluid-attenuated inversion recovery sequence involving the medulla and the right inferior cerebellar peduncle with moderate swelling, consistent with vasogenic oedema, without abnormalities on diffusion-weighted imaging sequence. PRES diagnosis was suspected and antihypertensive therapy was introduced to achieve a blood pressure goal < 140/90 mmHg, allowing a quickly favourable clinical course. Three months later, brain MRI demonstrated a complete clearance of the abnormalities, confirming the PRES diagnosis. Atypical MRI findings are possible with involvement of basal ganglia, brainstem or cerebellum, but in these cases, oedema is most of the time accompanied by the classical parieto-occipital region involvement. Vasogenic oedema strictly unilateral or involving exclusively the brainstem or the cerebellum are very rare and should prompt suspicion for an alternative diagnosis. That constitutes a crucial diagnosis challenge in neurology.

Keywords

Posterior reversible encephalopathy syndrome Hypertension Brainstem 

Notes

Author contributions

BH: study concept and design. EGM: critical revision of the manuscript for important intellectual content. ATB: critical revision of the manuscript for important intellectual content. OOW: critical revision of the manuscript for important intellectual content.

Funding

None.

Compliance with ethical standards

Conflict of interest

Benjamin Hebant declares that he has not conflict of interest. Evelyne Guegan-Massardier declares that she has not conflict of interest. Aude Triquenot-Bagan declares that she has not conflict of interest. Ozlem Ozkul-Wermester declares that she has not conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Belgian Neurological Society 2018

Authors and Affiliations

  • Benjamin Hebant
    • 1
    Email author
  • Evelyne Guegan-Massardier
    • 1
  • Aude Triquenot-Bagan
    • 1
  • Ozlem Ozkul-Wermester
    • 1
  1. 1.Department of NeurologyRouen University Hospital and University of RouenRouen CedexFrance

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