Abstract
Introduction
Posterior reversible encephalopathy syndrome (PRES) is a rare and complex disorder with variable clinical presentation and a typical magnetic resonance imaging (MRI) pattern of vasogenic edema with typical and atypical locations. It is often triggered by other diseases and drugs and the most prototypical association is with persistently elevated arterial pressure values. Among the potential cerebrovascular complications, intracranial bleeding has been described, but ischemic stroke is uncommonly reported.
Methods
We are presenting a case of a male patient with prolonged and sustained arterial hypertension acutely presenting with lacunar ischemic stroke involving the right corona radiata and composite MRI findings with the association of chronic small vessel disease (SVD) markers, acute symptomatic lacunar stroke, and atypical, central variant, posterior fossa dominant PRES. In the MRI follow-up, the white matter hyperintensities in T2-fluid attenuated inversion recovery (FLAIR sequences) due to PRES.
Discussion
The pathophysiology of PRES is not yet fully known, but the association with markedly increased values of arterial pressure is typical. In this context, ischemic stroke has not been considered in the clinical and neuroradiological manifestations of PRES and it has been only occasionally reported in the literature. In this case, the main hypothesis is that sustained hypertension may have triggered both manifestations, PRES, and ischemic stroke and the last one allowed to diagnose the first one.
Conclusions
Atypical variants of PRES are not so rare and it may also occur in typical triggering situations. The association with ischemic stroke is even rarer and it may add some clues to the pathomechanisms of PRES.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marialuisa Zedde, Rosario Pascarella, Manuela Napoli, and Claudio Moratti. The first draft of the manuscript was written by Marialuisa Zedde and Rosario Pascarella. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Zedde, M., Grisendi, I., Assenza, F. et al. Posterior reversible encephalopathy syndrome and acute ischemic stroke: an underreported association. Neurol Sci 45, 1249–1254 (2024). https://doi.org/10.1007/s10072-023-07223-8
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DOI: https://doi.org/10.1007/s10072-023-07223-8