60 year old with bilateral lung transplants presents with new seizures 





FLAIR



DWI



T1 post Gad



Findings:

Edema-like high T2, negative DWI, foci with patchy enhancement  predominately within white matter but also with deep grey and posterior grey matter involvement


DDX:

Encephalitis, Sarcoid, Lymphoma, atypical ischemic injury, PRES






Diagnosis:

PRES (Posterior Reversible Encephalopathy Syndrome) secondary to tacrolymus (drug to reduce transplant rejection)


Discussion:

Although classically occipital/parietal, PRES can often involve the anterior cortex as well as the deep grey nuclei and posterior fossa. It can often be distinguished from infarct by the lack of restricted diffusion althought in advanced cases hemorrhage and restricted diffusion can be seen.



Submitted by Farrah Jabeen, MD, UW Neuroradiology Fellow

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