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Fig 6. Patient 19 was a 54-year-old woman who had undergone gastric bypass surgery. She developed a severe pneumonia 2 months after surgery that eventually required intubation along with antibiotic treatment. This occurred while she was being treated at an outside hospital. The patient developed vision changes, confusion, and hypertension (200/100 mm Hg) during treatment with initial CT imaging reported as negative, and she was transferred to our facility for advanced management.
A-C, Brain MR imaging (FLAIR sequence) obtained 1 day after the development of toxicity and transfer demonstrated focal areas of vasogenic edema in the frontal lobes (arrows), parietal region (curved arrows), and occipital poles (open arrows) bilaterally with a mild degree of severity. Frontal lobe signal intensity is linear along the superior frontal sulcus (arrows), disconnected from the parietal abnormality (curved arrows) consistent with PRES and judged grade 1.
D, MRA at the time of initial MR imaging demonstrates extensive vasospasm of first-, second-, and third-order branches in the anterior cerebral artery (arrowheads), middle cerebral artery (arrows), and posterior communicating artery (short arrows) vessels bilaterally. A "node"-like appearance is seen at many branch points of the main parent vessels typical of spasm (black arrows 4G). Similar findings were also present in the posterior circulation.
E-F, Axial FLAIR image obtained on follow-up imaging study 11 days after the initial study demonstrates reversal of the vasogenic edema in all regions.
G, Repeat MRA obtained 11 days after the initial study demonstrates resolution of the extensive vasospasm with a near-normal appearance of all vessels (arrows).
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