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Case No. 135
0000-00-00~0000-00-00
출제자 : 관리자
Hit : 360
| Period | 0000-00-00~0000-00-00 |
|---|---|
| Diagnosis | |
| Clinical information | 54세 남자. 멍하게 앞만 보고 반응 없는 상태가 수분 정도 지속하여 내원. 과거력: 25년 전 DM 진단, 2년 전 CRF 진단. 17개월 전부터 CAPD 시작, 3개월 전 DM neuropathy 진단, 1개월 전부터 BP 조절되지 않고(SBP>180) dizziness, H/A 발생, 2일 전 SBP>200, DBP>140 으로 BP control 위해 내원. |
| Discussion | BRAIN MRI - 양측 cerebellar hemisphere에 high signal intensity lesions이 FLAIR에서 있으며, Diffusion weighted image 및 ADC map에서 vasogenic edema pattern으로 보임. 이들 병변은 enhancement를 동반하고 있지 않음. 진단: Posterior Reversible Encephalopathy Syndrome REVIEW PRES: unique pattern of brain vasogenic edema seen in the setting of neurotoxicity Imaging Patterns in PRES At CT/MR imaging, the brain typically demonstrates focal regions of symmetric hemispheric edema. The parietal and occipital lobes are most commonly affected, followed by the frontal lobes, the inferior temporal-occipital junction, and the cerebellum. DWI was instrumental in demonstrating that the areas of abnormality represent vasogenic edema. The edema usually completely reverses. Characteristic lesion locations such as the inferior temporal-occipital junction, superior frontal sulcus, and parietal/occipital region likely represent junctional expression between second-order branches or distal hemispheric branches. Linearly oriented focal deep white matter involvement may represent expression of PRES in the deep (intrahemispheric) watershed. Focal/patchy areas of PRES vasogenic edema may also be seen in the basal ganglia, brain stem, and deep white matter (external/internal capsule). Focal areas of restricted diffusion are uncommon (11%–26%). Hemorrhage is seen in approximately 15%. Basic Clinical Features of Neurotoxicity with PRES Clinical symptoms at toxicity are broad but include headache, vision change, paresis, emianopsia, nausea, and altered mentation. Symptoms may develop over several days or may be recognized only in the acute setting. Generalized seizures are common and coma may develop. In approximately 70%–80% of patients, moderate-to-severe hypertension is observed. |
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