Postcontrast Flair Mri Demonstrates Blood–brain Barrier Dysfunction in Pres

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, confusion, visual symptoms, and seizures, often triggered by acute hypertension. MRI may demonstrate vasogenic edema.1 We describe a patient with peculiar brain MRI and CSF findings, supporting the pathophysiologic theory of transient dysfunction of the blood–brain barrier (BBB). ### Case report. A 49-year-old Thai woman without previous neurologic history presented to the emergency room with nausea, severe headache, confusion, and markedly elevated blood pressure, as high as 204/123 mm Hg. On examination, she was somnolent, confused, performing only one-step commands, not responding to visual threats indicating cortical blindness, and showing an extensor plantar response on the right. In the emergency room, she developed one brief generalized seizure. Two days before, she had received a blood transfusion (4 units) for α-thalassemia intermedia induced hemolytic expansive pain but was clinically unremarkable otherwise. She was also treated for pulmonary tuberculosis with isoniazid, rifampicin, and ethambutol. Laboratory testing showed mildly elevated ASAT (57 U/L), ALAT (45 U/L), GGT (125 U/L), uric acid (617 μmol/L), and complete white (14,400 × 109/L), and erythrocyte cell count (6.17 × 1012/L). Hemoglobin level was normal. Urinalysis showed indications of nephropathy with proteinuria. MRI was performed (1.5 T MRI system): T2-weighted (T2W), T1W, MR angiography, diffusion-weighted, dynamic contrast enhanced …