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Posterior Reversible Encephalopathy Syndrome Presenting with Atypical Findings: Report of Two Cases
Paolo Cerrone1, Patrizia Sucapane2, Rocco Totaro2
1Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila (DISCAB), Italy.
Background:
Posterior reversible encephalopathy syndrome (PRES) is characterized by a variable association of symptoms including headache, consciousness impairment, visual disturbances, seizures, and focal neurological signs. Treating the underlying cause usually leads to partial or complete resolution of symptoms within days or weeks. Brain MRI findings include hyperintensities on T2-weighted sequences and their reversibility on follow-up exams. We describe two patients, one with an atypical clinical presentation characterized by a severe and prolonged impairment of consciousness and the other with atypical neuroimaging findings.
Case Presentation:
The first patient was a 42-year-old woman, with a negative medical history, presenting with seizures, lethargy, and left hemiparesis, 60 hours after uncomplicated delivery. Brain MRI showed an atypical pattern of alterations, with patchy asymmetric distribution in all lobes. Symptoms completely resolved after twelve days. The second patient was a 59-year-old woman with a history of hypertension, presenting with severe impairment of consciousness, vision loss, and seizures. Symptoms partially resolved after three weeks.
Conclusion:
PRES is characterized by reversible symptoms and radiological findings. Brain MRI usually shows widespread oedema in white matter with typical patterns. The cases we described suggest that PRES may presents with atypical symptoms and radiological manifestations, mimicking other neurological conditions.
Insights
Posterior reversible encephalopathy syndrome (PRES) can present with unusual symptoms and imaging findings. This condition, often reversible, may mimic other neurological disorders, highlighting the need for careful diagnosis.
Area of Science:
- Neurology
- Radiology
Background:
- Posterior reversible encephalopathy syndrome (PRES) involves diverse symptoms like seizures and consciousness impairment.
- Typical PRES shows reversible T2-weighted MRI hyperintensities, resolving with treatment of the underlying cause.
Observation:
- Two cases of PRES with atypical presentations are detailed.
- One patient exhibited prolonged consciousness impairment; the other had unusual neuroimaging findings.
Findings:
- PRES symptoms and MRI findings are usually reversible.
- Atypical PRES presentations can mimic other neurological conditions, complicating diagnosis.
Implications:
- Recognition of atypical PRES presentations is crucial for accurate diagnosis and management.
- Further research may elucidate the full spectrum of PRES manifestations.
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