Isolated pontine involvement in posterior reversible encephalopathy syndrome with coincidental acute ischaemic stroke.

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome characterised by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. We describe an unusual case of PRES with isolated pontine involvement with coincidental acute ischaemic stroke in a 60-year-old man who presented with headache, unsteadiness of gait, blurred vision and elevated blood pressure. MRI scan revealed an expanded pons with diffuse T2 and Fluid attenuated Inversion Recovery (FLAIR) hyperintensities and an acute infarct in the right temporal lobe. A diagnosis of PRES was considered most likely after exclusion of other differentials and the patient was started on antihypertensive treatment as for hypertensive encephalopathy. He became asymptomatic after controlling blood pressure and the follow-up MRI scan at 3 weeks showed complete resolution of the pontine high signals which confirmed the diagnosis of PRES.

• Authors: Indunil Deepthi Kumara Wijenayake Galagamage, Anjali Sujith, Ajith Kumara Kiringodage
• Journal: BMJ case reports (BMJ Case Rep) Vol. 12 Issue 4 (Apr 16 2019) ISSN: 1757-790X [Electronic] England
• PMID: 30996063 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antihypertensive Agents

Topics

• Antihypertensive Agents (therapeutic use)
• Gait Disorders, Neurologic (diagnostic imaging, etiology)
• Headache (etiology)
• Humans
• Hypertension (diagnostic imaging, etiology)
• Ischemia
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuroimaging
• Pons (diagnostic imaging, pathology)
• Posterior Leukoencephalopathy Syndrome (complications, diagnostic imaging, drug therapy, pathology)
• Stroke (diagnostic imaging, drug therapy, pathology)
• Treatment Outcome