Board Review 1 – Case 6

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case is a young postpartum patient with seizure and somnolence. The MRI shows FLAIR hyperintense white matter abnormalities in a predominantly posterior distribution. There is likely a small amount of subarachnoid hemorrhage.

The diagnosis is: posterior reversible encephalopathy syndrome, or PRES.

PRES has several names, including acute hypertensive encephalopathy, although this is also misleading because there are several causes, including hypertension and many medications. It is a primary disorder of vasoregulation, with edema occurring in subcortical white matter.