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Journal of Neurology Neurosurgery and Psychiatry 2002;73:83-84
© 2002 Journal of Neurology Neurosurgery and Psychiatry

LESSON OF THE MONTH

Don't throw in the towel! A case of reversible coma

S C Keswani, R Wityk

Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA

Correspondence to:
Correspondence to:
Dr Sanjay C Keswani, Pathology 509, Department of Neurology, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287, USA;
skeswani{at}jhmi.edu


ABSTRACT
A young woman with pre-eclampsia became unresponsive shortly after delivery. Examination revealed extensive brain stem dysfunction with absent pupillary light reflexes and decerebrate posturing. Computed tomography showed hypodensity throughout the brain stem, and it was initially thought that she had suffered catastrophic brain stem infarction. However, magnetic resonance diffusion imaging and apparent diffusion coefficient mapping showed that she had brain stem vasogenic oedema (posterior reversible encephalopathy syndrome, PRES), rather than cytotoxic oedema. With antihypertensive and supportive treatment, she recovered rapidly, and had no abnormalities on repeat imaging.

Keywords: posterior reversible encephalopathy syndrome; diffusion weighted MRI; eclampsia, hypertensive encephalopathy




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