case_images: PMC10868631_01
case_images: Representative axial computed tomographic images of the brain demonstrate hypodensities in the left (yellow arrows) greater than right (white arrows) parieto-occipital lobes raising the possibility of posterior reversible encephalopathy syndrome.
case_images: cureus-0016-00000052380-i01.jpg
case_images: PMC10868631_01_cureus-0016-00000052380-i01.jpg
case_images: FIG1
case_images: Subtle white matter hypodensities were seen in the bilateral occipital lobes with mild associated surrounding edema (Figure 1,2).
case_images: Axial fluid inversion recovery sequence (FLAIR) MR images through parieto-occipital lobes (A) and high frontoparietal (B) lobes extending to the posterior frontal lobes demonstrating multifocal subcortical areas of inversion recovery sequence (FLAIR) signal intensities in the parieto-occipital and high frontal subcortical areas corresponding to findings on the same day CT and compatible with posterior reversible encephalopathy syndrome.
case_images: cureus-0016-00000052380-i03.jpg
case_images: PMC10868631_01_cureus-0016-00000052380-i03.jpg
case_images: FIG3
case_images: Subsequent brain MRI showed multifocal edema within the deep cortical and subcortical white matter of the bilateral occipital lobe distribution without diffusion restriction or magnetic susceptibility, with overall findings compatible with uncomplicated PRES (Figure 3).
case_images: Axial FLAIR images demonstrate interval resolution of most subcortical parieto-occipital hyperintensities with minor residual Juxtacortical signal (yellow arrow) predominantly on the right parieto-occipital subcortical white matter compatible with the natural history of posterior reversible ischemic encephalopathy syndrome.
case_images: cureus-0016-00000052380-i04.jpg
case_images: PMC10868631_01_cureus-0016-00000052380-i04.jpg
case_images: FIG4
case_images: MRI obtained in the outpatient setting demonstrated interval resolution of most parieto-occipital fluid-attenuated inversion recovery (FLAIR) hyperintensities with minor residual juxtacortical FLAIR signal hyperintensities (Figure 4). Most striking was the temporal development of an apparent atrophy of the left medial temporal lobe that raised the question of MTS (Figure 5).
case_images: Representative coronal T1-weighted fast-spin echo (A) and post-contrast T1-weighted fast-spin echo (B) MR images through the temporal lobes during the posterior reversible encephalopathy syndrome (PRES) diagnosis demonstrate normal appearing right (A and B - green arrows) and left (A and B - yellow arrows) hippocampi without evidence of atrophy or enhancement. Representative coronal T1-weighted fast-spin echo (C) and T2-weighted fast-spin echo (D) 3 months after the diagnosis of PRES demonstrate asymmetric relative atrophy of the left mesial temporal lobe (C and D - yellow arrows) compared to the still normal appearing right temporal lobe (C and D - green arrows) with overall findings compatible with left mesial temporal sclerosis.
case_images: cureus-0016-00000052380-i05.jpg
case_images: PMC10868631_01_cureus-0016-00000052380-i05.jpg
case_images: FIG5
case_images: MRI obtained in the outpatient setting demonstrated interval resolution of most parieto-occipital fluid-attenuated inversion recovery (FLAIR) hyperintensities with minor residual juxtacortical FLAIR signal hyperintensities (Figure 4). Most striking was the temporal development of an apparent atrophy of the left medial temporal lobe that raised the question of MTS (Figure 5).