Case 28 - PRES: MRI

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Report

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MRI brain without contrast

HISTORY: Still's disease, atypical hemolytic uremic syndrome, worsening hypertension and concern for seizures.

TECHNIQUE:

Sagittal T1, axial FLAIR, axial diffusion-weighted imaging with ADC reconstruction and axial T2-weighted images of the brain are performed.

FINDINGS:

Comparison made to prior CT brain 9/3/2018.

On the current examination, there is no diffusion restriction present to indicate recent infarct. There is juxtacortical/subcortical relatively symmetric T2 FLAIR hyperintensity involving the posterior parietal lobes, bilateral occipital lobes with additional lesions in the posterior right temporal lobe and right middle frontal gyrus. There is mild associated edema. Incomplete suppression of CSF signal within the adjacent sulci raises possibility of associated subarachnoid hemorrhage. There is no midline shift. The ventricular system is not effaced and the basal cisterns are patent.

No focal suspicious marrow lesions. High midline scalp swelling noted. There is edema within the temporalis musculature bilaterally as well.

Orbits are grossly normal appearing.

Major intracranial arterial and venous sinus flow voids are preserved.

IMPRESSION:

Multifocal but relatively symmetric juxtacortical/subcortical T2 FLAIR hyperintensity within both cerebral hemispheres is most concerning for posterior reversible encephalopathy syndrome in the clinical setting of worsening hypertension. There is no evidence of completed infarct, however, there is suggestion of associated subarachnoid hemorrhage in the affected regions.

There is no substantial mass effect or midline shift. Basal cisterns are patent.

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Introduction

Introduction to the Emergency Brain Imaging Course

Clinical Scenario 1

New Neurologic Deficit

CLINICAL SCENARIO 2

Head Trauma Introduction

CLINICAL SCENARIO 3

Worst Headache of Life

CLINICAL SCENARIO 4

Found Down

CLINICAL SCENARIO 5

Fever and Seizure

CLINICAL SCENARIO 6

S/P, VPS, New Lethargy

Case 28 - PRES: MRI