A Case Report: Isolated Pontine Lesion in Hypertensive of a Pregnant Patient with Idiopathic Thrombocytopenia

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiologic diagnosis characterised by headache, seizures, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. PRES manifestation is a situation of medical emergency; however, it is a fully reversible condition, especially when diagnosed and treated immediately. The main problem lies in the impairment of cerebral blood flow autoregulation which, in turn, leads to endothelial dysfunction and vasogenic brain oedema. MRI indicates cerebral oedema in the occipital, temporal, and parietal lobes. Brainstem involvement is very rare in the literature. Idiopathic thrombocytopenia-related PRES is also rare in the literature. In this article, a case of PRES with only pons involvement in MRI after hypertensive attack in a pregnant patient with idiopathic thrombocytopenia is presented. PRES may present only brainstem involvement, as seen in this present case. Whether or not mild hypertension and mild thrombocytopenia found in this case are associated with limited disease should be evaluated. Prolonged spreading depression may have a role in the pathophysiology of PRES.