An eclamptic woman at 36 weeks gestation develops generalized seizures and visual obscuration. MRI brain shows symmetric T2/FLAIR hyperintensities with increased diffusivity in the parieto-occipital subcortical white matter bilaterally, sparing the calcarine cortex, with no restricted diffusion on ADC maps. The most likely diagnosis is:

• A Adrenoleukodystrophy
• B Bilateral posterior cerebral artery infarction
• C Progressive multifocal leukoencephalopathy
• D Posterior reversible encephalopathy syndrome ✓

Explanation

Symmetric parieto-occipital subcortical vasogenic oedema with facilitated diffusion (bright on ADC), occurring in pre-eclampsia or eclampsia and potentially reversible, defines PRES caused by failure of cerebral autoregulation and blood-brain barrier disruption. Posterior circulation infarcts show restricted diffusion on ADC maps and typically involve the calcarine cortex rather than sparing it.

Reference: Osborn's Brain, 2nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.