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Posterior reversible encephalopathy syndrome mimicking a cerebral tumour

Krupali Patel1, Andrew Durnford, Nicholas Owen

  • 1Department of Neurosciences, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK. krupali.patel@warwick.ac.uk

BMJ Case Reports
|July 5, 2012
PubMed

Insights

Posterior reversible encephalopathy syndrome (PRES) can mimic brain tumors on CT scans, even with asymmetrical findings. Prompt MRI diagnosis is crucial for this reversible condition, especially when hypertension is a factor.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Neurology

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by headache, confusion, seizures, and visual disturbances, typically associated with vasogenic edema.
  • Computed tomography (CT) scans often show non-specific findings or suggest PRES or stroke, while magnetic resonance imaging (MRI) usually reveals symmetrical vasogenic edema in the parietal and occipital lobes.

Observation:

  • A 58-year-old man presented with right homonymous hemianopia, hypertension, and ataxia.
  • Initial CT imaging suggested a left occipital lobe space-occupying lesion (SOL).
  • Contrast-enhanced MRI unexpectedly demonstrated bilateral vasogenic edema in the occipital and temporal lobes, characteristic of PRES.

Findings:

  • This case demonstrates that PRES can present with asymmetrical CT findings that mimic a space-occupying lesion.
  • Hypertension, a known predisposing factor for PRES, was present in this patient.
  • Symptoms resolved with antihypertensive therapy, confirming the reversible nature of the condition.

Implications:

  • Early and accurate diagnosis of PRES is vital for timely intervention and management.
  • MRI is essential for differentiating PRES from other neurological conditions, particularly stroke or tumors.
  • Recognizing atypical presentations of PRES, such as asymmetrical CT findings, improves diagnostic accuracy and patient outcomes.

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