Posterior reversible encephalopathy with brainstem involvement

Excerpt

A 39-year-old man was admitted to our hospital with a severe headache. He had a 2-year history of hypertension. No pathology was detected in the gastrointestinal and respiratory system examination. The blood pressure was 170/110 mmHg. Abdominal ultrasound revealed grade 1 increase in bilateral renal parenchyma echogenicity. The BUN was 69.6 mg/dl, creatinine 2.29 mg/dl, and phosphorus 4.61 mg/dl. Other biochemical parameters were normal. Renal parenchymal changes and laboratory results were compatible with hypertensive nephropathy. Doppler ultrasound found no renal vascular pathology. The hemoglobin value was low (10.2 g/day). Cranial magnetic resonance imaging (MRI) also showed pathological signal changes in parieto-occipital localization. In addition, hyperintensity and expansile appearance were observed in the mesencephalon, pons and middle cerebellar peduncle (Fig. 1). In MR spectroscopy, there was not any pathology other than minimal prominence in the choline peak. There were not any pathologic findings in diffusion-weighted images (DWI) and gradient echo sequences. On the basis of clinical and imaging examination, a diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES) with brainstem involvement was made. Clinical findings were improved after the patient was hospitalized, and treatment was started. After 20 days, it was observed that the radiological changes completely disappeared on MRI.

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