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Case report
Posterior reversible encephalopathy syndrome in acute pancreatitis: a rare stroke mimic
  1. Luke John Bonavia1,2,
  2. Justin Jackson2,3 and
  3. Richard Jurevics4
  1. 1Internal Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
  2. 2Medicine, Albury Wodonga Health Albury Campus, Albury, New South Wales, Australia
  3. 3Albury Clinical School, University of New South Wales, Albury, NSW, Australia
  4. 4Radiology, Regional Imaging, Albury, New South Wales, Australia
  1. Correspondence to Dr Luke John Bonavia; ljbonavia{at}gmail.com

Abstract

We report a 71-year-old woman who presented with Posterior Reversible Encephalopathy Syndrome (PRES) in the setting of acute pancreatitis. On day 3 of her admission, she developed transient right-sided upper and lower limb weakness, reduced visual acuity and encephalopathy, initially regarded as an acute stroke. Brain MRI fluid-attenuated inversion recovery (FLAIR) T2 imaging performed the same day confirmed occipital and parietal hyperdensities consistent with PRES. Her blood pressure never exceeded 150/75 mm Hg throughout the course of the admission. Our case demonstrates PRES in the setting of acute pancreatitis with only a relatively moderate elevation in blood pressure. In order to prevent unnecessary intervention in the setting of presumed acute stroke, it is important to consider the potential differential diagnoses including PRES as rare masquerade of acute stroke or transient ischaemic attack.

  • neuroimaging
  • neurology
  • stroke
  • brain stem / cerebellum
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Footnotes

  • JJ and RJ are joint senior authors.

  • Contributors LJB wrote the text and completed the literature review and table. JJ contributed to editing. RJ made the diagnosis and helped with image selection, conceptualisation of the radiological significance of case.

  • 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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