A first seizure episode

Clinical introduction A middle-aged man is brought to your ED following a self-limiting generalised tonic–clonic seizure. He is a smoker, with a history of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease, but no previous seizures. He is on aspirin and clopidogrel. On assessment, you see no evidence of trauma. He is confused, with a Glasgow Coma Scale 14 (E4, V4, M6) and mild global limb weakness but no focal neurology. He is newly hypertensive (210/140 mm Hg). His laboratory investigations and CT-brain are normal. An urgent MRI-brain is performed (see figure 1). Question What is the most likely diagnosis? Creutzfeldt-Jakob disease Posterior reversible encephalopathy syndrome Subacute sclerosing panencephalitis Subarachnoid haemorrhage Answer: B (Posterior reversible encephalopathy syndrome) The MRI axial FLAIR image shows increased enhancement in the posterior cerebral hemispheres and parafalcine white matter, but no evidence of...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research