Normal Magnetic Resonance Perfusion Imaging and Atypical Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease
- Author:
Yerim KIM
1
;
Yong Soo SHIM
Author Information
- Publication Type:Case Report
- Keywords: Posterior reversible encephalopathy syndrome; Brain magnetic resonance imaging; Brain Perfusion; Chronic Kidney Disease
- MeSH: Blood Pressure; Edema; Emergency Service, Hospital; Female; Follow-Up Studies; Frontal Lobe; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Nausea; Perfusion Imaging; Perfusion; Posterior Leukoencephalopathy Syndrome; Renal Insufficiency, Chronic; Seizures; Vomiting; White Matter
- From: Journal of Neurocritical Care 2017;10(1):41-45
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is classically characterized by symmetric vasogenic edema in the parietooccipital areas, but may occur at other sites with varying imaging appearances. CASE REPORT: A 55-year old female with chronic kidney disease (CKD) was admitted to the emergency room, presenting with nausea, vomiting and seizure. The initial blood pressure was 145/90 mmHg. Fluid attenuated inversion recovery demonstrated diffuse vasogenic edema in the bilateral cortical and subcortical white matters involving the frontal lobes. Perfusion magnetic resonance imaging (MRP) showed no hyper- or hypoperfusion at blood pressure levels of 140/50 mmHg. A follow-up magnetic resonance imaging at 3 weeks later demonstrated complete resolution of previous lesions. CONCLUSIONS: Earlier reports have demonstrated that PRES can occur in cases of atypical distributions, and features of imaging findings and normotensive settings. It is important to note that PRES is a dynamic process. As a result, we suggest that MRP must be considered in the appropriate temporal framework, to avoid misinterpretation of the other diseases, especially in CKD patients.
