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Research ArticleBrainE

Detection of Microhemorrhage in Posterior Reversible Encephalopathy Syndrome Using Susceptibility-Weighted Imaging

A.M. McKinney, B. Sarikaya, C. Gustafson and C.L. Truwit
American Journal of Neuroradiology May 2012, 33 (5) 896-903; DOI: https://doi.org/10.3174/ajnr.A2886
A.M. McKinney
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B. Sarikaya
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C. Gustafson
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C.L. Truwit
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    Fig 1.

    Patients with PRES on SWI, with the frequency of MH and other subtypes of hemorrhage.

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    Fig 2.

    A 50-year-old woman with seizure and a history of hypertension who presented with “mild” PRES-related cortical and subcortical edema (dashed arrows) on a 3T FLAIR MR image (A), with a small underlying MH (arrow) on SWI (B). On a follow-up 3T FLAIR MR image (C), the PRES-related edema had mostly resolved, while the tiny MH persisted on SWI (D).

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    Fig 3.

    A 51-year-old hypertensive woman with unilateral moderate edema from PRES on 3T FLAIR images. This likely occurred unilaterally because the patient had a severe (>90%) left carotid bulb stenosis, which presumably prevented hyperperfusion of the left cerebral hemisphere. B, There is a small amount of SAH (arrows) on SWI. On a follow-up 3T MR imaging performed 70 days later, FLAIR image (C) demonstrated resolution of the PRES-related edema, while the SAH had also resolved on SWI (D).

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    Fig 4.

    A 48-year-old woman with severe extent of PRES on 1.5T FLAIR images (A and B), based on involvement of the cerebellum (arrows, A), basal ganglia (arrows, B), and brain stem (not shown) and because the cerebral edema extends from the ventricular margin to the cortex (B). Although the severity was denoted, SWI on that presenting MR image (C) did not demonstrate any MH. Follow-up FLAIR image (D) obtained on the same magnet 22 days later had nearly normal findings, and no MHs were noted on the follow-up SWI images either (not shown).

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    Fig 5.

    A 52-year-old patient with cyclosporine toxicity. Eleven days before the seizure, a pretransplant surveillance 3T MR imaging with FLAIR (A), SWI (B), and postcontrast T1WI (C) had normal findings. At presentation for seizure with mild PRES, 1.5T FLAIR (D) showed vasogenic edema, with a new punctate MH on SWI (E) and cortical and leptomeningeal contrast enhancement on postcontrast T1WI (F). After the episode of PRES clinically resolved, a 5-month follow-up MR image at 3T showed no edema on FLAIR (G), while the MH remained on SWI (H). The MH also persisted on a 1.5T SWI at 9 months (I).

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    Fig 6.

    A 3-year-old child with a seizure from tacrolimus toxicity post–heart transplantation. Thirty-five days before the seizure, a pretransplantation surveillance MR imaging at 1.5T had FLAIR images that appeared to have normal findings (not shown). A, At presentation with PRES, a 1.5T FLAIR image demonstrates edema of the caudate nuclei and frontal lobes (arrows) as well as bilateral parieto-occipital edema (not shown), considered moderate severity. There was dark SAH (dashed arrows, B) and multiple frontal, parietal, and occipital cortical/subcortical MHs (arrows) on SWI (B and C) at presentation, which totaled >20 MHs. On the follow-up 3T MR imaging 8 days later, the regions of vasogenic edema are nearly resolved on FLAIR images (not shown), while SWI demonstrates improved but persistent SAH (dashed arrows, D); the MHs also persist on SWI (D and E). F, Review of SWI from the 35-day pretransplantation 1.5T MR imaging reveals that each of the >20 MHs (arrows) were present before the onset of PRES.

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American Journal of Neuroradiology: 33 (5)
American Journal of Neuroradiology
Vol. 33, Issue 5
1 May 2012
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Cite this article
A.M. McKinney, B. Sarikaya, C. Gustafson, C.L. Truwit
Detection of Microhemorrhage in Posterior Reversible Encephalopathy Syndrome Using Susceptibility-Weighted Imaging
American Journal of Neuroradiology May 2012, 33 (5) 896-903; DOI: 10.3174/ajnr.A2886

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Detection of Microhemorrhage in Posterior Reversible Encephalopathy Syndrome Using Susceptibility-Weighted Imaging
A.M. McKinney, B. Sarikaya, C. Gustafson, C.L. Truwit
American Journal of Neuroradiology May 2012, 33 (5) 896-903; DOI: 10.3174/ajnr.A2886
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