Brainstem reversible leukoencephalopathy syndrome

Abstract

A 39-year-old man presented with progressive headache, nauseas, blurriness and cortical blindness. Blood pressure: 230x140 mmHg. Glasgow score: 15. Fundoscopy revealed hypertensive retinopathy and papille de ma. Neurological examination was normal. Brain ma gnetic resonance imaging revealed area of swelling and high signal on FLAIR-weighted images on the brainstem and cerebral white-matter abnormalities (Figure 1). Hyperten sion management improved his clinical and radiological findings (Figure 2). Posterior reversible leukoencephalopathy syndrome (PRES), with classical reversible cerebral vasogenic edema, occurred predominantly in the posterior distribution (occipital and parietal lobes) on brain imaging1-3. The brainstem involvement is an atypical feature which may be encountered in midbrain (13%), pons (20%) and medulla oblongata (5%)1-3. This PRES variant should be differentiated from brainstem infarction, pontine glioma, infective encephalitis, central pontine myelinolysis and others demyelinating disorders because PRES is potentially full reversible after treatment1-3.