title: THE DIAGNOSTIC AND MANAGEMENT CHALLENGES FOR POSTERIOR REVERSIBLE LEUCOENCEPHALOPATHY SYNDROME.
abstract: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by epileptic seizures, headaches, altered mental status and focal neurological signs. Hypertension is the second most common condition associated with PRES. The 50-year-old-male patient with, right-sided hemiparesis and speech disturbances admitted to our clinic. His blood pressure at the emergency service was 220/140 mmHg. A left putaminal hematoma was seen in his CT and MRI. In his brain MRI, FLAIR and T2 -weighted sequences showed bilateral symmetric diffuse hyperintensities in the brain stem, basal ganglia, and occipital, parietal, frontal, and temporal lobes. After the intense antihypertensive drug treatment, his blood pressure came to normal limits within a week. During his hospitalisation he had a recurrent speech disturbance lasting an hour. His electroencephalography was normal. In his repeated diffusion weighted MRI, an acute lacunary infarct was seen on right centrum semiovale. Two months later, the control MRI showed only the previous lacuner infarcts and the chronic putaminal hematoma. We presented a case developping either a cerebral hemorrhage or a lacunar infarction due to PRES. The main reason of the following complications of the disease was delayed diagnosis. Uncontrolled hypertension was guilted for the events.
authors.forename: Eda Kiliç
authors.initials: EK
authors.lastname: Çoban
authors.forename: Sedat
authors.initials: S
authors.lastname: Gez
authors.forename: Batuhan
authors.initials: B
authors.lastname: Kara
authors.forename: Aysun
authors.initials: A
authors.lastname: Soysal
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D062186:Arterial Pressure / Q000187:drug effects*; D001933:Brain Stem / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000209:etiology; D003937:Diagnosis, Differential; D004401:Dysarthria / Q000209:etiology; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000209:etiology; D010291:Paresis / Q000209:etiology; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D011699:Putamen / Q000473:pathology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents