Normal Magnetic Resonance Perfusion Imaging and Atypical Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease

ABSTRACT

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is classically characterized by symmetric vasogenic edema in the parietooccipital areas, but may occur at other sites with varying imaging appearances. CASE REPORT: A 55-year old female with chronic kidney disease (CKD) was admitted to the emergency room, presenting with nausea, vomiting and seizure. The initial blood pressure was 145/90 mmHg. Fluid attenuated inversion recovery demonstrated diffuse vasogenic edema in the bilateral cortical and subcortical white matters involving the frontal lobes. Perfusion magnetic resonance imaging (MRP) showed no hyper- or hypoperfusion at blood pressure levels of 140/50 mmHg. A follow-up magnetic resonance imaging at 3 weeks later demonstrated complete resolution of previous lesions. CONCLUSIONS: Earlier reports have demonstrated that PRES can occur in cases of atypical distributions, and features of imaging findings and normotensive settings. It is important to note that PRES is a dynamic process. As a result, we suggest that MRP must be considered in the appropriate temporal framework, to avoid misinterpretation of the other diseases, especially in CKD patients.