Answer for BIR CoW 18 Nov 2018
ATYPICAL PRES
Findings
MRI findings: • Evidence of multiple T2 and FLAIR hyperintensities noted involving the cortical and subcortical areas of bilateral occipital,left temporal and bilateral frontal regions,bilateral basal ganglia showing diffusion restriction. • Multiple tiny blooming foci noted involving bilateral cerebral hemispheres. Impression: • Known case of eclampsia with possibility of atypical posterior reversible encephalopathy syndrome with multiple microhemorrhages.
Discussion
PRES: • Posterior reversible encephalopathy syndrome. • causes: preecclampsia,eclampsia,chemotherapy,immunosupressive drugs,HUS,TTP,renal failure,shock,tumour lysis syndrome. • Usually resolves with normalization of BP. TYPES: • Classic PRES parietooccipital region • Variant press superior frontal sulcus pattern (70%) Holohemispheric watershed pattern Cerebellum(50%),basal ganglia(30%),brainstem(20%),spinal cord(<10%) • Combinations very syndrome(>90%) CT: • Can be normal • Posterior cortical /subcortical hypodensities. • Gross hemorrhage rare(parenchymal>cSAH) MR: • T2/FLAIR hyperintensity(parietooccipital region) • T2*(GRE/Sw)shows hemorrhage in 15-25% • DWI usually but not invariably negative • Enhancement none/ mild Differencial diagnosis • Posterior circulation ischaemia-infarction • Top of basilar syndrome • Vasculitis • Status epilepticus • Hypoglycemia • Thrombotic microangiopathy • Sinovenous thrombosis. • Reversible cerebral vasoconstriction syndrome
Findings
MRI findings: • Evidence of multiple T2 and FLAIR hyperintensities noted involving the cortical and subcortical areas of bilateral occipital,left temporal and bilateral frontal regions,bilateral basal ganglia showing diffusion restriction. • Multiple tiny blooming foci noted involving bilateral cerebral hemispheres. Impression: • Known case of eclampsia with possibility of atypical posterior reversible encephalopathy syndrome with multiple microhemorrhages.
Discussion
PRES: • Posterior reversible encephalopathy syndrome. • causes: preecclampsia,eclampsia,chemotherapy,immunosupressive drugs,HUS,TTP,renal failure,shock,tumour lysis syndrome. • Usually resolves with normalization of BP. TYPES: • Classic PRES parietooccipital region • Variant press superior frontal sulcus pattern (70%) Holohemispheric watershed pattern Cerebellum(50%),basal ganglia(30%),brainstem(20%),spinal cord(<10%) • Combinations very syndrome(>90%) CT: • Can be normal • Posterior cortical /subcortical hypodensities. • Gross hemorrhage rare(parenchymal>cSAH) MR: • T2/FLAIR hyperintensity(parietooccipital region) • T2*(GRE/Sw)shows hemorrhage in 15-25% • DWI usually but not invariably negative • Enhancement none/ mild Differencial diagnosis • Posterior circulation ischaemia-infarction • Top of basilar syndrome • Vasculitis • Status epilepticus • Hypoglycemia • Thrombotic microangiopathy • Sinovenous thrombosis. • Reversible cerebral vasoconstriction syndrome
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!