Reversible posterior leukoencephalopathy syndrome: case report

Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome characterized by sudden onset of headache, altered consciousness, impaired vision, seizures. PRES pathogenesis is not entirely clear – it's believed, that main role is played by cerebral autoregulatory dysfunction caused by arterial hypertension. Case report: a 32-year-old pregnant (17+4 weeks) female was hospitalized with headache, vision impairment and sensory disturbances on the left side of the body. On admission patient had left homonymous hemianopsia, superficial hemi-type sensory disturbances on the left side of the body, positive Babinski sign. CT of the head showed formed ischemia with hemorrhagic imbibition in the territory supplied by the right MCA and PCA territory. Transcranial Doppler ultrasound showed fast blood flow rate in the right MCA M1, M2 and left MCA M1 segments, indicating vasospasm. T2 weighted and FLAIR MRI showed increased signal intensity in the right parietal and occipital lobe with transition to temporal lobe in cortical and subcortical layers, cortical gyral flattening due to edema, corpus callosum and rear portion of the midbrain edema. Treatment with nimodipine improved patient's health. After a week blood flow rate in the right MCA M1 segment normalized. In a few weeks all of the symptoms disappeared. One month later MRI showed residual signs of blood flow impairment in the territory supplied by the right MCA. PRES is a rare syndrome, which resolves in a few days or weeks if diagnosed and treated properly. Usually there are no residual symptoms after prompt treatment, therefore MRI is indicated in patients with typical clinical manifestation and risk factors.