Isolated pons involvement in Posterior Reversible Encephalopathy Syndrome: Case report and review of the literature

M. Ferrara, Pietro Di Viesti, Vincenzo Inchingolo, R. Latino, T. Popolizio, S.A. De Cosmo, F. Pugliese, M.A. Leone

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Abstract

Background Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-radiological syndrome, usually reversible and with a favorable prognosis, which recognizes a variety of etiologies and clinical patterns and is likely due to an impairment in cerebral blood flow autoregulation. It is typically characterized by subcortical, predominantly parieto-occipital, vasogenic brain oedema in patients with acute-subacute neurological symptoms. Infratentorial oedema on neuroimaging has been mostly described in association with the typical supratentorial pattern and seldom as isolated. Case report We report a case of PRES with isolated pons involvement on MRI. A woman affected by Turner syndrome, epilepsy, slight mental deficiency, obesity and hypothyroidism, experienced a progressive gait and standing impairment, worsening in the last 2 weeks. At admission blood pressure was 220/110 mmHg. Brain MRI showed a wide FLAIR signal hyperintensity on T2-weighted sequences affecting the entire pons, without contrast enhancement. Clonidine, doxazosine, furosemide and telmisartan were effective in restoring normal blood pressure. Pons hyperintensity completely resolved on MRI 3 weeks later, together with return to normal neurological examination. Conclusions Though isolated infratentorial involvement in PRES recognizes several causes, hypertension, which is a common feature in Turner syndrome, would have played a key role in our case with solely pons MRI T2-hyperintensity. © 2016 The Author(s)
Original languageEnglish
Pages (from-to)51-54
Number of pages4
JournaleNeurologicalSci
Volume6
DOIs
Publication statusPublished - 2017

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Keywords

  • A typical Posterior Reversible Encephalopathy Syndrome
  • Clinico-radiological dissociation
  • Infratentorial vasogenic oedema
  • Pontine oedema

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