Age: 71
Sex: Male
Indication: Renal transplant patient with altered mental status
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Case #27
Findings
- Patchy T2/FLAIR signal hyperintensity involving the bilateral thalami, posterior limbs of the internal capsules, cerebellar hemispheres, superior and middle cerebellar peduncles, periaqueductal gray matter, pons, and medulla
- Background of patchy and confluent T2/FLAIR hyperintensities in the subcortical and periventricular white matter
- Remote bilateral basal ganglia lacunar infarcts with remote with foci of susceptibility artifact bilaterally
- Generalized cerebral volume loss with ex vacuo enlargement of the ventricular system
- No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus
- Mucosal thickening of bilateral anterior ethmoid air cells
- Bilateral pseudophakia
Diagnosis
- Atypical posterior reversible encephalopathy syndrome (PRES)
Sample Report
Patchy T2/FLAIR signal hyperintensity involving the bilateral thalami, posterior limbs of the internal capsules, cerebellar hemispheres, superior and middle cerebellar peduncles, periaqueductal gray matter, pons, and medulla, for which the differential diagnosis includes an atypical posterior reversible encephalopathy syndrome (PRES), Wernicke encephalopathy or other toxic/metabolic abnormality, and an infectious process such as viral encephalitis.
No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus.
Background of remote lacunar infarcts, punctate mineralization and/or remote microhemorrhages in the bilateral basal ganglia, advanced chronic small vessel disease, and generalized cerebral volume loss with ex vacuo enlargement of the ventricular system.
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