PMC4307725_01
T2 weighted magnetic resonance imaging of Patient 1, showing hyperintensity within the occipital lobe.
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The next day, MRI/MRA (magnetic resonance angiogram) head and neck with and without contrast showed symmetric T2 signal intensity within the occipital lobes, without evidence of infarction or enhancement, most consistent with PRES (Figure 1).
PMC4307725_02
T2 weighted magnetic resonance imaging of Patient 2, with hyperintensity of posterior parietal and occipital lobes.
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MRI of the head without contrast was obtained which showed T2 and fluid-attenuated inversion recovery (FLAIR) signal hyperintensity located in a symmetric fashion within the bilateral occipital and posterior parietal lobes, interpreted as characteristic of PRES (Figure 2).
PMC4307725_03
Initial T2 weighted magnetic resonance imaging of Patient 3 on second emergency department visit, showing increased T2 intensity throughout the cortical and subcortical gray matter of the bilateral frontal, parietal, occipital and posterior temporal lobes.
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T2 and T2 FLAIR signal intensity throughout the cortical and subcortical gray matter of the bilateral frontal, parietal, occipital and posterior temporal lobes, with scattered areas of restricted diffusion within the posterior cortex of the bilateral parietal regions, concerning for PRES (Figure 3). The patient underwent lumbar puncture, with normal cerebrospinal fluid studies.
T2 weighted magnetic resonance imaging of Patient 3 on hospital day 4 with massive right-sided temporo-occipital intraparenchymal hemorrhage.
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On hospital day four, the patient was noted to have a sudden decline in mental status and repeat MRI showed a massive right-sided temporoccipital intraparenchymal hemorrhage (Figure 4).