9/21 Wednesday case presentation with JLo: PRES

A elderly man with a pmh of diabetes, CKD, HTN, HLD and hx of splenic inf CAD with dilatation of his coronary arteries who presented with 2 days of severe, new onset headache and worsening vision changes.  Initial CT demonstrated bilateral occipital hypodensities ? stroke.  MRI confirmed ischemic stroke.
-DDx in this case was broad.  The headache was highly suggestive of a non-ischemic etiology.  Ischemic strokes normally do NOT present with headache.  Additionally, the broad distribution of the findings on CT scan suggested the possibility of a vasculitic process.
-DDx included ischemic stroke, PRES, and vasculitis
-PRES typically presents with: headache, seizures, visual disturbances, and altered consciousness – this patient met 2/4 of these criteria
-Kozak’s rads tips –> Acute ischemic stroke on DWI MRI will appear as hyperintense “bright”.  Ischemic stroke on ADC mapping ischemia will  will be dark “hypointense”.  PRES will have opposite imaging characteristics.

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