Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 29, 2014
Posterior Reversible Encephalopathy Syndrome
- Posterior reversible encephalopathy syndrome (PRES) can be attributed to numerous causes; common ones include hypertension and antitransplant medications, and tacrolimus is one such cause of PRES.
- Clinical Features: Nonspecific, including seizures and change in mental status
- Key Diagnostic Features
- Confluent signal abnormality involving the subcortical white matter, especially the occipital lobes
- The frontal lobes and other white matter regions of the brain can also be involved.
- Most such lesions disappear following discontinuation of the offending agent/treatment of the underlying cause.
- Rarely, progression of vasogenic edema to cause infarcts, especially involving the cortex, can be seen.
- Microhemorrhages
- Confluent signal abnormality involving the subcortical white matter, especially the occipital lobes
- DDx:
- Superior sagittal sinus thrombosis
- Radiation-induced change
- Toxic and metabolic disorders
- Rx: Discontinuation of the offending agent; treatment of the underlying cause and observation
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