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
THANK YOU
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