NeuroradiologyDate 25.02.15

History

• A 40 year male presented with

• Headache for 2 days 6 days ago.

• Weakness of Rt LL f/b Rt UL since 2 days.

• Dizziness and swaying while walking since 2 days.

O/E• Pt afebrile : PR 98/min : BP 170/100 rt UL supine position.

• Nervous system• Bilateral papilloedema. Rt side UMN facial palsy.

• Tone –increased in Rt UL&LL. Power 3/5 in UL & 4/5 in LL : brisk knee jerk on right side . plantar bilateral flexors. Sensory examination N.

• Gait ataxia.

17.02.15

T 1

T 2

Differential diagnosis

• ADEM• PRES• Ischemic stroke.

21.02.15

• CSF Glucose, Protein normal 10 Cells 100% lymphocytes.

• 2D ECHO ? Vegetations in AML Hyper echoic mass (2.5ₓ 1.5)in LV.

Central variant PRES• PRES is a clinico radiologic syndrome that typically involves

Parieto occipital and posterior frontal area with cortical and sub cortical edema.

• In more severe or atypical cases, • Periventricular white matter, • basal ganglia, • brainstem, • anterior frontal and • temporal cortexes can also be involved.

• Involvement of the basal ganglia or brainstem (central variant) is seen in 10-20% of PRES cases.

• Current theory is - endothelial cell dysfunction occurs within smaller, perforating vessels supplying the brainstem and basal ganglia, possibly related to increased sensitivity in these regions.

• Imaging features- DWI appeared normal in all patients with central-variant PRES.

• Susceptibility-weighted imaging, which was performed in four of five patients, depicted multiple punctate micro hemorrhages in two patients.

Case 1- 41 yr male , post lung transplantation ,on immuno suppression.

• Atypical radiological features of PRES…

1. Contrast enhancement2. Diffusion restriction3. Hemorrhagic PRES

Contrast enhancement

Diffusion restriction

Hemorrhagic PRES

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