Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; Posterior Leukoencephalopathy Syndrome ; diagnosis ; etiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications

Stroke mimickers are common, and they represent a diagnostic dilemma for clinicians. Many, like posterior reversible encephalopathy syndrome (PRES), are easily reversible. The manifestation of PRES is characterised by headaches, convulsions, altered mental functioning and blindness. In most cases, computed tomography of the brain will show hypodense lesions in the parieto-occpitial lobe, which only further confounds the physician. Although this syndrome is uncommon, prompt and accurate recognition allows early treatment, which has been shown to produce favourable outcomes. Herein, we report the case of a 54-year-old woman, who presented with PRES, as an acute manifestation of systemic lupus erythematous (SLE) and lupus nephritis. The patient was initially thought to be experiencing an ischaemic stroke, but the diagnosis was later changed. On management of her underlying condition, her symptoms resolved. PRES should be recognised as an acute emergency manifestation of SLE. It should not be mistaken for an ischaemic stroke as inappropriate treatment could have adverse outcomes.
Acute Disease ; Biopsy ; Diagnosis, Differential ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; diagnosis ; Middle Aged ; Posterior Leukoencephalopathy Syndrome ; diagnosis ; etiology ; Tomography, X-Ray Computed

Biomarkers ; blood ; Brain ; diagnostic imaging ; pathology ; Brain Edema ; etiology ; pathology ; Child ; Diagnosis, Differential ; Electroencephalography ; Guillain-Barre Syndrome ; complications ; diagnosis ; therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Posterior Leukoencephalopathy Syndrome ; complications ; diagnosis ; therapy ; Radiography

REVERSIBLE posterior leukoencephalopathy syndrome (RPLS) is a rare neurological syndrome characterized by headache, altered mental status, seizures, and visual disturbance, associated with reversible white matter changes.1 It has been commonly reported in patients with severe hypertension and pre-eclampsia. Here we report a case with nephrotic syndrome complicated by RPLS.
Brain ; diagnostic imaging ; drug effects ; pathology ; Child ; Female ; Humans ; Magnetic Resonance Imaging ; Nephrotic Syndrome ; complications ; diagnosis ; drug therapy ; Posterior Leukoencephalopathy Syndrome ; complications ; diagnosis ; drug therapy ; Tomography, X-Ray Computed ; Treatment Outcome

Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.
Acute Kidney Injury/complications ; Brain/radiography ; Diagnosis, Differential ; Female ; Humans ; Infarction, Middle Cerebral Artery/diagnosis/radiography ; Lung Transplantation ; Magnetic Resonance Imaging ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/complications/*diagnosis ; Tomography, X-Ray Computed