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Fig 5. Patient 2 was a 73-year-old woman who had undergone gastric surgery. Her baseline blood pressure of 157/77 mm Hg. She developed aspiration and pneumonia. Bronchial washings and blood cultures grew Pseudomonas aeruginosa. Neurotoxicity developed 6 days after positive cultures with altered mental status and blood pressure 128/80 mm Hg.
A-C, Brain MR imaging (FLAIR sequence) obtained at the time of toxicity demonstrates an unusual pattern of vasogenic edema in the parietal region bilaterally much greater on the left (curved arrows) involving both cortex and some extension to the deep white matter judged grade 2.
D, MRA obtained at the same time as imaging demonstrates diminutive severely "pruned" intracranial vessels, in particular MCA branches (arrows).
E, Follow-up brain MR imaging (FLAIR sequence) obtained 1 month after initial imaging demonstrates complete resolution of the vasogenic edema bilaterally shown here only on the left (curved arrow). Incidental subdural hygromas are also present.
F, Follow-up MRA also obtained 1 month after initial imaging demonstrates marked improvement in vessel visualization with partial reversal of the severe "pruning" and spasm in the MCA branches (arrows) bilaterally. The patient’s mental status completely normalized.
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