PMC6336622_01
Characteristic imaging findings in PRES-SCI without hemisphere lesions involved. (A) Axial FLAIR of hemisphere and T2 of medullar. (A1, A2) There was no hyperintensity of the bilateral parietal and occipital lobes in FLAIR brain MRI. (A3) Hyperintensity of the brain only limited in the medully in T2. (B) Axial FLAIR hyperintensity of the medulla, and sagittal T2 hyperintensity in upper cervical spinal cord extending to the lower thoracic spine on admission. (C, D) follow-up MRI on the 3rd (C) and 10th (D) day of the spinal cord. Sagittal T2 of the medulla and cervical spinal cord after admission shows resolution of the prior hyperintensity (compare to A3and B), which was also true on the thoracic spine MRI (not shown). (E, F), Scanning Laser Ophthalmoscope examination showed hypertension related retinopathy in both eyes (E, left; F right). Fundus photograph of the eyes shows optic nerve edema, macular star pattern of exudates in the macula, and cotton-wool spots and flame hemorrhages. MRI = magnetic resonance imaging, PRES-SCI = posterior reversible encephalopathy syndrome with spinal cord involvement.
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F1
Magnetic resonance imaging (MRI) of the brain (Fig. 1A(A1, A2)) on the admission showed that there were no lesions in either hemisphere, though MRI of the spinal cord on admission (Fig. 1B) and the third day (Fig. 1C) showed T2- weighted images and fluid-attenuated inversion recovery (FLAIR) hyperintensity in the medulla, and upper cervical spinal cord that extended to the lower thoracic spine. Scanning laser ophthalmoscope examination showed hypertension related retinopathy in both eyes (Fig. 1E-F). Tablets (I) (Novartis Pharma Stein AG, Switzerland) (5 mg per day) for the hypertension, his symptoms rapidly improved. Ten days after admission, a follow-up MRI of the spinal cord showed disappearance of previous imaging finding in T2-weighted image in the medulla and spinal cord (Fig. 1D).