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Posterior Reversible Encephalopathy Syndrome Mimicking Brainstem Infarction: A Dilemma.

Tsung-Han Ho1, Chia-Lin Tsai1, Yaw-Don Hsu1

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Acta Neurologica Taiwanica
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Summary

Central-variant posterior reversible encephalopathy syndrome (PRES) can mimic brainstem infarction on CT scans. Early MRI is crucial for diagnosing PRES and avoiding misdiagnosis, especially in patients with progressive neurological decline.

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Area of Science:

  • Neurology
  • Radiology
  • Neuroscience

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is a neurological condition.
  • Central-variant PRES can present with symptoms mimicking other brainstem pathologies.
  • Accurate diagnosis is essential for appropriate patient management.

Observation:

  • A 49-year-old male presented with vertigo, cognitive decline, and gait instability.
  • Initial cranial CT revealed hypodense pons lesions, leading to a presumed diagnosis of brainstem infarction and initiation of antiplatelet therapy.
  • Brain MRI demonstrated vasogenic edema, confirming central-variant PRES.

Findings:

  • Central-variant PRES can radiologically mimic acute brainstem infarction on CT.
  • Misdiagnosis can lead to inappropriate treatment, such as antiplatelet agents.

Implications:

  • This case highlights the importance of considering central-variant PRES in the differential diagnosis of brainstem lesions on CT, especially with progressive neurological symptoms.
  • Cranial MRI is essential for accurate diagnosis and appropriate management of central-variant PRES.