Two cases of posterior reversible encephalopathy syndrome resembling brainstem glioma

• Published in: Clinical neurology and neurosurgery Vol. 114; no. 7; pp. 1062 - 1065
• Main Authors: Tsutsumi, Masateru, Akimoto, Jiro, Nakajima, Nobuyuki, Hashimoto, Ryo, Haraoka, Jo
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.09.2012; Elsevier; Elsevier Limited
• Subjects: 1HMR spectroscopy; 3-Iodobenzylguanidine; Adult; Biological and medical sciences; Blood pressure; Brain - pathology; Brain cancer; Brain Stem Neoplasms - pathology; Brainstem; Catecholamines - blood; Disease; Female; Glioma - pathology; Hashimoto Disease - blood; Hashimoto Disease - pathology; Heart rate; Hospitalization; Humans; Hypertension; Hypertensive encephalopathy; Hypertensive Encephalopathy - drug therapy; Hypertensive Encephalopathy - etiology; Magnetic Resonance Imaging; Medical imaging; Medical sciences; Middle Aged; MRI; Neurology; Neurosurgery; Positron-Emission Tomography; Posterior Leukoencephalopathy Syndrome - pathology; Posterior reversible encephalopathy syndrome; Radiopharmaceuticals; Spectrum analysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Veins & arteries; 1HMR spectroscopy; Posterior reversible encephalopathy syndrome; MRI; Brainstem; Hypertensive encephalopathy; Hypertension; Nervous system diseases; Cardiovascular disease; Nuclear magnetic resonance imaging; Cerebral disorder; Spectrometry; Glioma; Surgery; Encephalopathy; Central nervous system disease; Tumor; HMR spectroscopy
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.02.027

[...]the key to differential diagnosis includes: the preservation of the brainstem structure on MRI, limited abnormal signals on the DWI [2,3,8], without enhancement after injection of gadolinium, the presence of abnormal signals in both cerebellar hemispheres and PCA regions, and most importantly whether or not brainstem variant PRES can be suspected. [...]the confirmation of a non-tumor pattern via 1HMR spectroscopy may also by useful [4,10]. The current cases both exhibited improvement in symptoms through anti-hypertensive treatment, and the abnormal signals were resolved by the 18th and 20th days of hospitalization. [...]the latent internal diseases were detected and early treatment was possible.3 Conclusion We reported 2 cases of PRES with brainstem-predominant imaging findings.