Open AccessPosterior reversible encephalopathy syndrome in acute pancreatitis: a rare stroke mimic
Author(s) -
Luke Bonavia,
Justin Jackson,
Richard Jurevics
Publication year - 2020
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-2019-232228
Subject(s) - medicine , posterior reversible encephalopathy syndrome , fluid attenuated inversion recovery , acute pancreatitis , stroke (engine) , encephalopathy , neurology , blood pressure , acute stroke , differential diagnosis , hypertensive encephalopathy , magnetic resonance imaging , anesthesia , surgery , cardiology , radiology , pathology , mechanical engineering , psychiatry , tissue plasminogen activator , engineering
We report a 71-year-old woman who presented with Posterior Reversible Encephalopathy Syndrome (PRES) in the setting of acute pancreatitis. On day 3 of her admission, she developed transient right-sided upper and lower limb weakness, reduced visual acuity and encephalopathy, initially regarded as an acute stroke. Brain MRI fluid-attenuated inversion recovery (FLAIR) T2 imaging performed the same day confirmed occipital and parietal hyperdensities consistent with PRES. Her blood pressure never exceeded 150/75 mm Hg throughout the course of the admission. Our case demonstrates PRES in the setting of acute pancreatitis with only a relatively moderate elevation in blood pressure. In order to prevent unnecessary intervention in the setting of presumed acute stroke, it is important to consider the potential differential diagnoses including PRES as rare masquerade of acute stroke or transient ischaemic attack.