Revealing image of arterial spin labelling in posterior reversible encephalopathy syndrome

A 31-year-old postpartum woman presented with a generalised tonic–clonic seizure on the seventh day of delivery. The antepartum period was uneventful, and there was no significant medical history. Examination showed elevated blood pressure (160/100) and a disoriented patient. MRI of the brain showed hyperintensities in bilateral parieto-occipital areas (figure 1A–E) suggestive of posterior reversible encephalopathy syndrome (PRES). Pulsed arterial spin labelling (ASL) showed hyperperfusion in corresponding areas (figure 1F,G). Electroencephalography showed delta range slowing in the left parieto-occipital leads. She was treated with intravenous magnesium sulfate, oral levetiracetam, lacosamide and nifedipine. She recovered in 2 days, and all drugs were withdrawn 6 weeks later. PRES is caused by hypertensive emergencies, autoimmune and renal diseases, septicaemia, chemotherapeutic and immunosuppressive medications.1 Impaired cerebral perfusion and vasogenic oedema are the pathophysiological hallmarks. These changes are predominantly seen in the parietal and occipital lobes.2 Diagnosis is made...
Source: Postgraduate Medical Journal - Category: General Medicine Authors: Tags: Images Source Type: research