Demographics:
55 years old, Female
Indication:
Bilateral vision loss
Findings
- Extensive T2/FLAIR signal hyperintensity involving the bilateral parietal and occipital lobes involving gray and white matter with associated gyral swelling and cortical restricted diffusion
- Additional areas of cortical and subcortical white matter T2/FLAIR hyperintensity involving the bilateral superior parietal lobules and posterior frontal lobes
- Multifocal areas of susceptibility artifact centered in the bilateral parietooccipital cortices
- Remote lacunar infarct in the left caudate head
- Severe mucosal thickening of the bilateral maxillary sinuses and bilateral ethmoid air cells with fluid layering in the left maxillary sinus and complete opacification of the right maxillary sinus. Mild mucosal thickening of the sphenoid and frontal sinuses
Diagnosis
Posterior reversible encephalopathy syndrome (PRES)
Sample Report
Findings are most suggestive of posterior reversible encephalopathy syndrome (PRES) involving the bilateral parietooccipital regions and to a lesser extent the bilateral posterior frontal lobes. Associated areas of developing cortical infarction with multiple small parietooccipital cortical hemorrhages. No evidence of herniation or hydrocephalus.
Remote lacunar infarct in the left caudate head.
Severe mucosal thickening of the paranasal sinuses. Correlate with clinical signs of acute sinusitis.
Discussion