Ferrara M, Di Viesti P, Inchingolo V, Latino RR, Popolizio T, De Cosmo SA, Pugliese F, Leone MA. Isolated pons involvement in Posterior Reversible Encephalopathy Syndrome: Case report and review of the literature.
eNeurologicalSci 2017;
6:51-4. [PMID:
29260011 DOI:
10.1016/j.ensci.2016.11.008]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022] Open
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.
Clinical and radiological findings of PRES are heterogeneous with possible atypical presentations: in this regard an accurate differential diagnosis is mandatory in order to provide prompt intervention.
Isolated pons involvement has been rarely described. A key feature may be poor clinical presentation in spite of a radiological pattern of severity.
Severe hypertension acts as the more frequently reported predisposing factor for isolated pontine PRES
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