Intracerebral Hemorrhage, Diffusion Restriction and Contrast Enhancement on Magnetic Resonance Imaging in Posterior Reversible Encephalopathy Syndrome Secondary to Antepartum Eclampsia: Case Report and Review of Literature

Saurabh Bansal, Ramandeep Bansal, Manoj Kumar Goyal, Paramjeet Singh and Vivek Lal

Abstract

Background: The diagnosis of posterior reversible encephalopathy syndrome (PRES) is based on a characteristic radiological picture in the appropriate clinical setting. Knowledge of atypical radiological presentations of PRES is essential to avoid misdiagnosis.
Methods: We present a PRES patient secondary to antepartum eclampsia with atypical radiological manifestations and briefly review the literature regarding radiology of PRES.
Results: A 23-year-old woman presented with headache, vomiting, visual disturbances, seizures and encephalopathy at 30 weeks gestational age with blood pressure of 146/100 mm Hg. She was diagnosed with eclampsia and PRES based on clinical signs, magnetic resonance imaging (MRI) and computed tomographic scanning of the brain revealing signal changes suggestive of PRES. In addition to changes typical of PRES, there was evidence of cerebellar involvement, diffusion restriction and bleeding in the right temporo-parietal regions, changes which are considered atypical for PRES. She was managed conservatively and improved gradually. Repeat MRI done after three months showed resolution of signal abnormalities. At eight months follow up, she has had a complete recovery.
Conclusions: Knowledge of atypical radiological manifestations of PRES helps clinicians in identifying this rare, potentially reversible disorder and avoid unnecessary diagnostic and therapeutic interventions. Our case further aids to the repertoire of atypical radiological findings of PRES.

Published on: November 22, 2018
doi: 10.17756/jnpn.2018-024
Citation:  Bansal S, Bansal R, Goyal MK, Singh P, Lal V. 2018. Intracerebral Hemorrhage, Diffusion Restriction and Contrast Enhancement on Magnetic Resonance Imaging in Posterior Reversible Encephalopathy Syndrome Secondary to Antepartum Eclampsia: Case Report and Review of Literature J Neuroimaging Psychiatry Neurol 3(2): 27-29.

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