Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome.
The posterior reversible encephalopathy syndrome (PRES) is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord (apart from the typical parieto-occipital lesions)--an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome.
Department of Internal Medicine, Shri Maharaja Hari Singh Hospital, Srinagar, India.
Naseer A
NA
Choh
Majid
M
Jehangir
Muddassir
M
Rasheed
Tajamul
T
Mira
Irfan
I
Ahmad
Suhil
S
Choh
D000293:Adolescent; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D054038:Posterior Leukoencephalopathy Syndrome / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology*
Intensive Care Med. 2007 Feb;33(2):230-6
17119920
Neurology. 1999 Aug 11;53(3):652-4
10449143
Radiographics. 2007 Jul-Aug;27(4):919-40
17620459
AJNR Am J Neuroradiol. 2006 Nov-Dec;27(10):2179-90
17110690
AJNR Am J Neuroradiol. 2009 Apr;30(4):755-7
18854436
J Neuroimaging. 2010 Jan;20(1):22-8
19021847
Arch Neurol. 2008 Feb;65(2):205-10
18268188
AJNR Am J Neuroradiol. 2008 Jun;29(6):1036-42
18356474
AJR Am J Roentgenol. 2007 Oct;189(4):904-12
17885064
AJNR Am J Neuroradiol. 2007 Aug;28(7):1320-7
17698535
AJNR Am J Neuroradiol. 2008 Jun;29(6):1043-9
18403560
J Neurol Neurosurg Psychiatry. 2009 Jan;80(1):35
19091707