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Case report
Tumour-like presentation of atypical posterior reversible encephalopathy syndrome with prominent brainstem involvement
  1. Vincenzo Di Stefano1,
  2. Marianna Gabriella Rispoli1,
  3. Marco Onofrj1 and
  4. Maria Vittoria De Angelis2
  1. 1Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
  2. 2Depatment of Neurology, "SS. Annunziata" Hospital, Chieti, Italy
  1. Correspondence to Dr Vincenzo Di Stefano; vincenzo19689{at}


Typical posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterised by bilateral white matter oedema, which is usually symmetrical and totally reversible in 2–3 weeks. A 46-year-old man presented with a persistent headache and visual blurring in the right eye. On admission, the clinical examination revealed minimal unsteadiness of gait and elevated blood pressure. A brain MRI showed a hyperintense signal on T2-weighted sequences in the whole brainstem, extended to the spinal cord (C2–C6), the left insula and the right cerebellum. When his blood pressure was controlled, his symptoms gradually improved. The follow-up MRI scan at 3 weeks revealed a dramatic regression of the hyperintense lesions on T2-weighted sequences. The differential diagnosis of PRES is very wide, especially in the case of conspicuous brainstem involvement. Treatable causes of white matter oedema should be always kept in mind to avoid misdiagnosis and prevent complications, such as intracranial haemorrhage.

  • neurology
  • Brain stem/cerebellum
  • neuroimaging
  • neuro-oncology
  • radiology

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  • VDS and MGR are joint first authors.

  • VDS and MGR contributed equally.

  • Contributors VDS and MVDA provided clinical care to the patient, conception and design, acquisition of the data, analysis and interpretation of the data; MGR and MO revised the article critically for intellectual content; all authors contributed to and have approved the final version of the manuscript.

  • 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.

  • Patient consent for publication Obtained.

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

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