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PRES – Posterior Reversible Encephalopathy Syndrome — SCE Neurology MCQ

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ModerateCerebrovascular DiseasePRES – Posterior Reversible Encephalopathy SyndromeSCE Neurology

A 32-year-old woman on the combined oral contraceptive pill presents with sudden onset severe headache, seizures, visual disturbance, and confusion. Blood pressure is 195/120 mmHg. MRI brain shows bilateral symmetric posterior white matter T2/FLAIR hyperintensity predominantly in the parieto-occipital regions with associated vasogenic oedema on ADC maps. What is the most likely diagnosis?

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Correct answer: C — Posterior reversible encephalopathy syndrome

PRES is characterised by acute headache, seizures, visual disturbance, and confusion with bilateral posterior-predominant white matter vasogenic oedema on MRI. Risk factors include severe hypertension, eclampsia/pre-eclampsia, immunosuppressants (ciclosporin, tacrolimus), and autoimmune conditions. The hallmark MRI finding is posterior-predominant T2/FLAIR hyperintensity with vasogenic (not cytotoxic) oedema on ADC maps. Treatment involves blood pressure control and removal of the causative factor. A: Posterior stroke would show restricted diffusion. C: CVST shows venous thrombosis on MRV. D: ADEM has multifocal disseminated lesions. E: PRES IS hypertensive encephalopathy — they overlap.

Reference: RCP National Clinical Guideline for Stroke (2023); Fugate & Rabinstein PRES Review (2015)