Abstract Details

Title Brainstem Presentations of Posterior Reversible Encephalopathy Syndrome: Two Case Reports

Topic General Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-004

Objective To illustrate rare presentations of posterior reversible encephalopathy syndrome (PRES) with T2 FLAIR lesions predominantly in the brainstem.

Background With the increasing availability of MRIs, PRES has become more readily identifiable as a clinical entity. Most commonly seen in the young to middle-aged adult population, patients can present with headaches, encephalopathy, or seizures. Those with hypertension, renal failure, or immunocompromised are at increased risk. PRES lesions are best appreciated as T2 FLAIR hyperintensities, or as hyperintense or isotense lesions on ADC, indicative of reversible vasogenic edema. Lesions tend to be symmetric and are classically observed posteriorly in the frontal, parietooccipital, and cerebellar hemispheres. Less commonly these lesions can be seen in the brainstem. This is a self-limiting disease with lesions typically resolving within days to weeks.

Design/Methods NA

Results

1: A 36-year-old male with obesity presented with daily persistent headaches, but no neurologic deficits. MRI brain showed extensive areas of abnormal white matter signal with the most significant involvement in the pons. He underwent a lumbar puncture which was bland, however, at that time blood pressure was noted to be elevated with systolics in the 200s. Lesions resolved with blood pressure treatment. A year later he re-presented emergently with uncontrolled hypertension and shortness of breath and repeat MRI brain again showed increased white matter lesions in the pons and diffusely, as well as a small acute stroke.

2: A 31-year-old female with refractory hypertension was hospitalized for subarachnoid hemorrhage, left facial droop and left facial sensory loss in the setting of severely elevated blood pressure. MRI brain showed T2 hyperintense pontomedullary lesions. Lumbar puncture demonstrated only mild protein elevation. Blood pressure was corrected with notable clinical improvement, and repeat MRI brain showed improvement in the lesions.

Conclusions While uncommon, the above case reports highlight how PRES can present with brainstem lesions.

Authors/Disclosures
Sunita Nadendla, DO PRESENTER	Dr. Nadendla has nothing to disclose.
Amanda F. Abuaf, MD (University of Wisconsin)	Dr. Abuaf has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech.

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