Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes

Area of Science:

• Neurology
• Radiology
• Nephrology

Background:

• Posterior reversible encephalopathy syndrome (PRES) presents with focal neurological deficits, often mimicking stroke.
• Atypical presentations of PRES pose diagnostic challenges, necessitating a high clinical suspicion.
• Cerebral CT perfusion (CTP) is a primary tool for acute stroke imaging, assessing cerebral blood flow dynamics.

Purpose of the Study:

• To highlight the diagnostic utility of CTP in a case of PRES.
• To illustrate how CTP aids in differentiating PRES from ischemic stroke.
• To discuss the role of CTP in managing PRES, particularly in complex patient populations.

Main Methods:

• Case report of an elderly bone marrow transplant recipient with focal neurological deficits.
• Utilized cerebral CT perfusion (CTP) imaging as a key diagnostic modality.
• Reviewed the pathophysiology of PRES and its imaging characteristics.

Main Results:

• CTP demonstrated abnormalities consistent with PRES, aiding in its diagnosis.
• The findings on CTP helped distinguish PRES from an acute ischemic stroke.
• Early diagnosis via CTP facilitated timely and appropriate management.

Conclusions:

• CTP is a valuable tool for diagnosing PRES, especially when clinical presentation is atypical.
• Recognizing abnormal CTP findings in PRES is crucial for differentiating it from stroke mimics.
• This case underscores the importance of CTP in the management of PRES in at-risk patients.