Altered sensorium Case 2014
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CASE PRESENTATION
Dr. Sethu SadanadnanRegistrarRadiology
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21yr old female patientk/c/o SLE on steroidsPresented with GTCS and Altered sensorium
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DD1.PRES/RPLS2.Posterior circulation ischemia/infarction3.Vasulitis4.Hypoglycemia5.Sinovenous thrombosis6.Thrombotic microangiopathies7.Status epilepticus8.Reversible cerebral vasoconstriction syndrome
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DD1.P R E S / R P L S2.Posterior circulation ischemia/infarction3.Vasulitis4.Hypoglycemia5.Sinovenous thrombosis6.Thrombotic microangiopathies7.Status epilepticus8.Reversible cerebral vasoconstriction syndrome
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Posterior Reversible Encephalopathy Syndrome:Posterior reversible encephalopathy
syndrome (PRES) is a clinicoradiological entity
Posterior reversible encephalopathy syndrome (PRES) is well recognized because of its typical imaging appearance, that is involvement of the parieto-occipital regions
Other brain regions may also be affected and unusual imaging manifestations are observed frequently
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Classic PRES Atypical PRESB/L symmetrical parieto
occipital cortical and subcortical regions
Frontal lobes
Cortical watershed zones
Basal gangliaBrainstem
Cerebellum Spinal cord
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PATHOGENESIS
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CAUSESPreeclampsia/ eclampsia
Infection /Sepsis / Shock
Autoimmune Disease- SLE, WG, PAN , systemic
sclerosis
Cancer chemotherapy, immunosuppressive
drugs
Renal failure
Tumor lysis syndrome
Thrombotic microangiopathies ( HUS/TTP)
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Enhancement (up to 37%) : cortical, leptomeningeal, parenchymal or pachymeningeal
Restricted diffusion (11-26%) Hemorrhage (10.5-17.1%) : parenchymal or
subarachnoid Altered brain perfusion : regional decreased
or increased, depends on disease time course Unilateral hemispheric involvement (2.6%)
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