A Case of Posterior Reversible Encephalopathy Syndrome Confused With Encephalitis

Abstract

We report a case of posterior reversible encephalopathy syndrome (PRES), a clinical picture with symptoms such as headache and unconsciousness, and requiring differential diagnosis with various central nervous system disorders including encephalitis. A 36-year-old female was admitted with altered mental status, somnolence and absurd speech starting a few days after giving labour prior to one week. Neck stiffness and meningeal irritation signs were absent. Body temperature was 37.2 degrees C, and blood pressure was 150/90 mmHg. White blood cells were 16 000 /mm(3) (89% polymorphonuclear). Cerebrospinal fluid findings were unremarkable. Cranial computed tomography scan without contrast revealed approximately 5-cm diameter patchy hypodense lesions in left occipital region. Furthermore, axial T2-weighted images showed hyperintenseareas without mass effect and axial T1-weighted images showed hypointense areas in occipital regions and in basal ganglia and capsula interna levels bilaterally in cranial magnetic resonance imaging without contrast. PRES diagnosis was made with clinical and neuroradiological findings. She was followed with symptomatic treatment, and her hypertension was brought under control. She became conscious after 4th day of hospitalization, and nearly complete regression of her previous lesions were observed in cranial MR repeated on 9th day of hospitalization.