J Korean Soc Magn Reson Med.  2013 Jun;17(2):144-148. 10.13104/jksmrm.2013.17.2.144.

Irreversible Hemorrhagic Complication of Recurrent Posterior Reversible Encephalopathy Syndrome in a Patient with Systemic Lupus Erythematosus

• Kim HK
• Lee HJ
• Shin KM

• KMID: 2099873
• DOI: http://doi.org/10.13104/jksmrm.2013.17.2.144

Abstract

Although most cases of posterior reversible encephalopathy syndrome (PRES) are reversible, irreversible lesions as a form of hemorrhage or infarction have been described. PRES as a complication of systemic lupus erythematosus (PRES-SLE) is associated with hypertension or use of immunosuppressive agents. We present a case of recurrent atypical PRES-SLE, which showed restricted diffusion in the first manifestation of SLE, resulted in parenchymal hemorrhagic transformations in the recurrent episode.

Keyword

Posterior reversible encephalopathy syndrome; Hemorrhage; SLE; MRI

MeSH Terms

Diffusion
Hemorrhage
Humans
Hypertension
Immunosuppressive Agents
Infarction
Lupus Erythematosus, Systemic
Immunosuppressive Agents

Figure

• 

  Fig. 1 A 29-year-old woman with SLE. T2-weighted image of magnetic resonance imaging shows increased signal intensities in the gray and white matter of parieto-temporo-occipital lobes (a). Most of the lesions exhibited high values on the apparent diffusion coefficient map, however area of diffusion restriction was seen in the gray matter of left temporoocciptal lobe on diffusion weighted image (b) and apparent diffusion coefficient map (c).

• 

  Fig. 2 MRI after one month shows near complete resolution of the bilateral posterior cerebral lesions.

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  Fig. 3 MRI after two months shows extensive edematous lesions with hemorrhagic transformation in the left frontoparietal and temporooccipital lobes and right occipital lobe on T2WI (a), diffusion weighted image (b) and apparent diffusion coefficient map (c) and CT (d1, d2 and d3).

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