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Posterior reversible encephalopathy syndrome — SCE Neurology MCQ

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HardNeuroimagingPosterior reversible encephalopathy syndromeSCE Neurology

Five days after delivery, a patient develops headache, seizures and visual disturbance with blood pressure 188/116 mmHg. MRI shows bilateral parieto-occipital vasogenic oedema with increased ADC. What is the diagnosis?

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Correct answer: A — Posterior reversible encephalopathy syndrome associated with severe postpartum hypertension

The best answer is “Posterior reversible encephalopathy syndrome associated with severe postpartum hypertension”. The hypertensive postpartum setting and reversible posterior vasogenic oedema are classic for PRES, requiring urgent blood-pressure and seizure management. “Bilateral posterior-cerebral artery infarction” can be reasonable in another presentation, but it does not account for the defining feature here. “Herpes-simplex encephalitis” can be reasonable in another presentation, but it does not account for the defining feature here. “Migraine aura” can be reasonable in another presentation, but it does not account for the defining feature here. “Mitochondrial stroke-like episode” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: Royal College of Physicians National Clinical Guideline for Stroke: https://www.strokeguideline.org/