1. Patient 16 is a 39-year-old woman status post bowel resection and appendectomy for Crohn disease being maintained on antibiotics and steroids with baseline blood pressure of 100/60 mm Hg. Brain imaging was obtained when she developed headache, vertigo, and ...
Patient 16 is a 39-year-old woman status post bowel resection and appendectomy for Crohn disease being maintained on antibiotics and steroids with baseline blood pressure of 100/60 mm Hg. Brain imaging was obtained when she developed headache, vertigo, and moderate elevation in blood pressure (145/95 mm Hg). A, Axial MR imaging (FLAIR sequence) results demonstrate vasogenic edema in occipital lobes (open arrows) consistent with PRES. Additional areas of vasogenic edema consistent with PRES were present in the frontal and parietal regions, and abnormality of signal intensity with restricted diffusion was also present in the medial right cerebellar hemisphere (not shown). B, MR angiogram obtained 1 day after toxicity demonstrates marked vessel irregularity in the PCAs bilaterally (arrows), greater on the right than on the left. C, Left vertebral catheter angiogram (selected posterior magnified lateral view) demonstrates a beaded appearance (arrow) and focal vasoconstriction and vasodilation (arrowhead) of right third- and fourth-order branches of the PCA along with a beaded appearance of the branches of the distal medial posterior inferior cerebellar artery on the left (open arrow). D Results of follow-up MR angiogram obtained 3 days after initial study demonstrate normalization of the vessel irregularity and marked improvement in vessel caliber (arrows) consistent with reversal of the vasospasm/arteritis confirmed on conventional angiography. Follow-up MR imaging demonstrated reversal of the PRES pattern.
W.S. Bartynski, and J.F. Boardman AJNR Am J Neuroradiol 2008;29:
©2008 by American Society of Neuroradiology