J Neurocrit Care.  2017 Jun;10(1):41-45. 10.18700/jnc.170003.

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

• Kim Y
• Shim YS

• KMID: 2385886
• DOI: http://doi.org/10.18700/jnc.170003

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.

Keyword

Posterior reversible encephalopathy syndrome; Brain magnetic resonance imaging; Brain Perfusion; Chronic Kidney Disease

MeSH Terms

Blood Pressure
Edema
Emergency Service, Hospital
Female
Follow-Up Studies
Frontal Lobe
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Nausea
Perfusion Imaging*
Perfusion*
Posterior Leukoencephalopathy Syndrome*
Renal Insufficiency, Chronic*
Seizures
Vomiting
White Matter

Figure

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  Figure 1. Initial brain-magnetic resonance imaging. (A, B) FLAIR demonstrated diffuse vasogenic edema in the bilateral cortical and subcortical white matters involving the frontal lobes (arrows). (C) DWI revealed non-significant high signal. (D) ADC map demonstrated high signal intensities in these regions. FLAIR, fluid attenuated inversion recovery; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.

• 

  Figure 2. Normal perfusion MRI at blood pressure levels of 140/50 mmHg. (A) Cerebral blood volume, (B) cerebral blood flow, (C) mean transit time, (D) time to peak. MRI, magnetic resonance imaging.

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  Figure 3. FLAIR after 3 weeks. The follow-up magnetic resonance imaging demonstrated complete resolution of previous lesions. FLAIR, fluid attenuated inversion recovery

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