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CASE REPORT
Isolated pontine involvement in posterior reversible encephalopathy syndrome with coincidental acute ischaemic stroke
  1. Indunil Deepthi Kumara Wijenayake Galagamage1,
  2. Anjali Sujith2 and
  3. Ajith Kumara Kiringodage3
  1. 1 Stroke, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
  2. 2 Radiology, Basildon & Thurrock University Hospitals, Basildon, UK
  3. 3 DMOP, Basildon University Hospital, Basildon, Essex, UK
  1. Correspondence to Dr Indunil Deepthi Kumara Wijenayake Galagamage, iwijedk95{at}gmail.com

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome characterised by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. We describe an unusual case of PRES with isolated pontine involvement with coincidental acute ischaemic stroke in a 60-year-old man who presented with headache, unsteadiness of gait, blurred vision and elevated blood pressure. MRI scan revealed an expanded pons with diffuse T2 and Fluid attenuated Inversion Recovery (FLAIR) hyperintensities and an acute infarct in the right temporal lobe. A diagnosis of PRES was considered most likely after exclusion of other differentials and the patient was started on antihypertensive treatment as for hypertensive encephalopathy. He became asymptomatic after controlling blood pressure and the follow-up MRI scan at 3 weeks showed complete resolution of the pontine high signals which confirmed the diagnosis of PRES.

  • hypertension
  • stroke
  • brain stem / cerebellum
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Footnotes

  • Contributors IDKWG was involved in acute management of the patient and outpatient follow-up; discussed this case in the neuroradiology multidisciplinary meeting where it was suspected to have PRES; got the consent from the patient for publishing the case; and actively participated in the literature review and writing of the case report. AS made the initial radiological diagnosis of PRES and participated in writing the case report. AKK actively participated in literature review, writing of the case report, proofreading and submitting.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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