Open AccessIsolated pontine involvement in posterior reversible encephalopathy syndrome with coincidental acute ischaemic stroke
Author(s) -
Indunil Deepthi Kumara Wijenayake Galagamage,
Anjali Sujith,
Ajith Kumara Kiringodage
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-227132
Subject(s) - posterior reversible encephalopathy syndrome , medicine , fluid attenuated inversion recovery , blurred vision , asymptomatic , hyperintensity , pons , magnetic resonance imaging , stroke (engine) , cardiology , encephalopathy , blood pressure , neuroimaging , radiology , anesthesia , surgery , mechanical engineering , psychiatry , engineering
Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome characterised by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. We describe an unusual case of PRES with isolated pontine involvement with coincidental acute ischaemic stroke in a 60-year-old man who presented with headache, unsteadiness of gait, blurred vision and elevated blood pressure. MRI scan revealed an expanded pons with diffuse T2 and Fluid attenuated Inversion Recovery (FLAIR) hyperintensities and an acute infarct in the right temporal lobe. A diagnosis of PRES was considered most likely after exclusion of other differentials and the patient was started on antihypertensive treatment as for hypertensive encephalopathy. He became asymptomatic after controlling blood pressure and the follow-up MRI scan at 3 weeks showed complete resolution of the pontine high signals which confirmed the diagnosis of PRES.