Atypical posterior reversible encephalopathy syndrome with albuminocytological dissociation and late emerging neuroradiological findings: A case report

ABSTRACT

Posterior reversible encephalopathy syndrome (PRES) is a central nervous system disorder accompanied by vasogenic edema in white matter that is usually located in temporo-parieto-occipital area. Typically, PRES is presented with headaches, seizures, and change of consciousness. The most common etiologic factor is fluctuations in blood pressure.

An eighty-eight-year-old female patient was evaluated because of her acute confused state. Medical history revealed hypertension. Blood pressure was 190/100 mmHg. The initial examination showed impaired consciousness. Radiological investigations of brain showed chronic ischemic lesions. Albuminocytological dissociation was detected in CSF examination. On the 6^th day of admission, cranial MRI was repeated. Radiological findings were typical for PRES.

The cranial MRI is a valuable diagnostic tool for the diagnosis of the PRES but, as in our case, despite the subtle clinical and radiological findings presented during admission, repeated MRI and CSF examination may contribute to a definite diagnosis. This case is remarkable for severe protein elevation in CSF, irreversible fatal course and radiographic evidence of vasogenic edema occurred subsequently.

KEYWORDS:

• PRES
• hypertension
• encephalopathy
• MRI findings

Acknowlegements

We would like to thank the patient’s family for permission to publish this report.

Contribution statement

Yaprak Ozum Unsal Bilgin was involved with the conception, data collection, writing and critical review of the article

Neslihan Eskut was involved with the conception, data collection, writing and supervision of the article

Aslı Koskderelioglu was involved with the conception, supervision and critical review of the article.

Muhtesem Gedizlioglu was involved with the conception, supervision and critical review of the article.

Declaration of interest

The contents of the paper and the opinions expressed within are those of the all authors, and it was the decision of the all authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.