Normal Magnetic Resonance Perfusion Imaging and Atypical Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease

• Main Authors: Yerim Kim, Yong Soo Shim
• Format: Article
• Language: English
• Published: The Korean Neurocritical Care Society 2017-06-01
• Series: Journal of Neurocritical Care
• Subjects: Posterior reversible encephalopathy syndrome; Brain magnetic resonance imaging; Brain Perfusion; Chronic Kidney Disease
• Online Access: http://www.e-jnc.org/upload/pdf/jnc-170003.pdf
• ISSN: 2005-0348; 2508-1349

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.