altered sensorium case 2014

CASE PRESENTATION

Dr. Sethu SadanadnanRegistrarRadiology

21yr old female patientk/c/o SLE on steroidsPresented with GTCS and Altered sensorium

DD1.PRES/RPLS2.Posterior circulation ischemia/infarction3.Vasulitis4.Hypoglycemia5.Sinovenous thrombosis6.Thrombotic microangiopathies7.Status epilepticus8.Reversible cerebral vasoconstriction syndrome

DD1.P R E S / R P L S2.Posterior circulation ischemia/infarction3.Vasulitis4.Hypoglycemia5.Sinovenous thrombosis6.Thrombotic microangiopathies7.Status epilepticus8.Reversible cerebral vasoconstriction syndrome

Posterior Reversible Encephalopathy Syndrome:Posterior reversible encephalopathy

syndrome (PRES) is a clinicoradiological entity

Posterior reversible encephalopathy syndrome (PRES) is well recognized because of its typical imaging appearance, that is involvement of the parieto-occipital regions

Other brain regions may also be affected and unusual imaging manifestations are observed frequently

Classic PRES Atypical PRESB/L symmetrical parieto

occipital cortical and subcortical regions

Frontal lobes

Cortical watershed zones

Basal gangliaBrainstem

Cerebellum Spinal cord

PATHOGENESIS

CAUSESPreeclampsia/ eclampsia

Infection /Sepsis / Shock

Autoimmune Disease- SLE, WG, PAN , systemic

sclerosis

Cancer chemotherapy, immunosuppressive

drugs

Renal failure

Tumor lysis syndrome

Thrombotic microangiopathies ( HUS/TTP)

Enhancement (up to 37%) : cortical, leptomeningeal, parenchymal or pachymeningeal

Restricted diffusion (11-26%) Hemorrhage (10.5-17.1%) : parenchymal or

subarachnoid Altered brain perfusion : regional decreased

or increased, depends on disease time course Unilateral hemispheric involvement (2.6%)