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Neuroimaging is an invaluable diagnostic tool for sorting through the vast array of etiologies that underlie altered mental status (AMS). Head computed tomography (CT) without contrast is the primary modality for evaluation of AMS and should be complemented by MR imaging in cases of negative CT but high clinical concern. Studies to maximize brain imaging efficiency and improve the yield of positive scans through the utilization of clinical and laboratory pre-scan diagnostics are ongoing. However, imaging remains the gold standard due to its rapidity with which certain diagnoses can be made or excluded., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that, although characteristically reversible, can be fatal or result in long-term disability in a subset of patients. Our aim was to identify factors associated with poor discharge outcome in PRES patients., Materials and Methods: We retrospectively reviewed the clinical and radiological records of all patients with PRES admitted at our tertiary care medical center from 2007 to 2014. They were divided based their modified Rankin Score at discharge and compared for their baseline variables, clinical, laboratory and imaging features. Poor outcome was defined by a modified Rankin scale 2-6 and was subdivided based on the primary mechanism that led to poor outcome., Results: Out of 100 PRES subjects, 36% had poor discharge outcomes. Factors associated with poor outcomes on univariate analysis were history of diabetes mellitus, coma, high Charlson comorbidity index, post-transplantation, autoimmune condition, lack of systolic or diastolic hypertension, elevated blood urea nitrogen and involvement of the corpus callosum. On multivariate analysis, only prior diabetes mellitus odd ratio (OR) = 6.8 (95% CI 1.1-42.1, p = 0.04), corpus callosum involvement (OR = 11.7; 95% CI 2.4-57.4, p = 0.00) were associated with poor outcome. Poor outcome also correlated with increased length of hospital stay (OR = 7.9; 95% CI 1.3-49.7, p = 0.03)., Conclusion: Large prospective studies incorporating serial blood glucose values and advanced imaging studies are required to validate these findings.

Objective: Challenging differential diagnosis Background: Pheochromocytoma, a rare catecholamine-secreting tumor, often presents with paroxysmal or sustained hypertension, tachycardia, headache, and diaphoresis. Timely diagnosis is essential to prevent adverse complications. Less common presentations include pheochromocytoma crisis, with severe neurological and cardiac complications. Case Report: We report a unique case of a 25-year-old woman who initially presented with pheochromocytoma-induced hypertensive encephalopathy and acute coronary syndrome. Echocardiography revealed takotsubo-like cardiomyopathy, and magnetic resonance imaging of the brain revealed posterior reversible encephalopathy syndrome. Initial treatment focused on controlling her blood pressure and supporting cardiac function. Due to her recovering from immediate crisis and absence of further symptoms, the patient refused further follow-up. However, she eventually experienced another episode of hypertensive crisis 2 years later. Subsequent investigations with 24-h urine tests revealed elevated vanillylmandelic acid levels (7.93 mg/24 h), normetanephrine (2638.72 µg/24 h), and nor-metanephrine to creatinine ratio (3546.67) and normal urine metanephrine levels (195.92 µg/24 h) and metanephrine to creatinine ratio (263.33). Contrast-enhanced computed tomography of the abdomen revealed a 4.3 x 3.1 x 4-cm mass in the right adrenal gland. A DOTATATE positron emission tomography scan revealed a 3.9 x 4.3 x 2.7-cm localized right adrenal pheochromocytoma. Biochemical testing and adrenal imaging revealed a previously undiagnosed pheochromocytoma. Following targeted medical therapy and right adrenalectomy, the patient achieved complete resolution of her hypertension and associated symptoms. Conclusions: Our case is a unique simultaneous presentation of posterior reversible encephalopathy syndrome and takotsubo- like cardiomyopathy, highlighting the importance to consider pheochromocytoma in acute neurological and cardiac presentations, even in the absence of typical symptoms. [ABSTRACT FROM AUTHOR]

Background: Uraemia causes a generalised encephalopathy as its most common neurological complication. Isolated brainstem uraemic encephalopathy is rare. We report a case of fatigable ptosis and complex ophthalmoplegia in brainstem uraemic encephalopathy. Case presentation: A 22-year-old Sri Lankan man with end stage renal failure presented with acute onset diplopia and drooping of eyelids progressively worsening over one week. The patient had not complied with the prescribed renal replacement therapy which was planned to be initiated 5 months previously. On examination, his Glasgow coma scale score was 15/15, He had a fatigable asymmetrical bilateral ptosis. The ice-pack test was negative. There was a complex ophthalmoplegia with bilateral abduction failure and elevation failure of the right eye. The diplopia did not worsen with prolonged stare. The rest of the neurological examination was normal. Serum creatinine on admission was 21.81 mg/dl. The repetitive nerve stimulation did not show a decremental pattern. Magnetic resonance imaging (MRI) of the brain demonstrated diffuse midbrain and pontine oedema with T2 weighted/FLAIR hyperintensities. The patient was haemodialyzed on alternate days and his neurological deficits completely resolved by the end of the second week of dialysis. The follow up brain MRI done two weeks later demonstrated marked improvement of the brainstem oedema with residual T2 weighted/FLAIR hyperintensities in the midbrain. Conclusions: Uraemia may rarely cause an isolated brainstem encephalopathy mimicking ocular myasthenia, which resolves with correction of the uraemia. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Acute necrotizing encephalopathy of childhood (ANEC) is a rare form of acute encephalopathy in children that is characterized by rapid and progressive deterioration in the patient's clinical condition. Our aim in reporting the case is to highlight the importance of early diagnoses and aggressive early management of ANEC to achieve a better outcome. We report the case of a 5-year-old girl who presented with acute progressive encephalopathy with bilateral symmetrical thalamic involvement and brainstem lesion proceeded by a flu-like illness. Case Report: We report a 5-year-old girl who was previously healthy. She presented with rapid progressive encephalopathy and status epilepticus following a flu-like illness. Her magnetic resonance imaging (MRI) showed significance symmetrical bilateral thalamic enhancement with brainstem lesions, which is consistent with the diagnosis of ANEC of childhood, and her initial electroencephalogram (EEG) showed severe encephalopathy. Despite extensive management of ANEC, the patient showed a poor prognosis. Conclusions: ANEC is a rare, specific, devastating condition in the pediatric population. Early diagnosis and aggressive management should be initiated immediately to avoid the high mortality associated with the condition. Furthermore, to highlight the importance of the clear history of the patient who presented with rapid and progressive deterioration in the level of consciousness and status epilepticus proceeded by viral illness, a rapid neuroradiological images such as brain MRI should be obtained to confirm the diagnosis of this rare condition. We also seek to increase awareness of this disorder among healthcare workers and general practitioners. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the longitudinal trajectory of brain growth in children with opsoclonus-myoclonus ataxia syndrome. We performed a longitudinal evaluation of brain volumes in pediatric opsoclonus-myoclonus ataxia syndrome patients compared with age- and sex-matched healthy children. Patients and Methods: This longitudinal case-control study included brain magnetic resonance imaging (MRI) scans from consecutive pediatric opsoclonus-myoclonus ataxia syndrome patients (2009-2020) and age- and sex-matched healthy control children. FreeSurfer analysis provided automatic volumetry of the brain. Paired t tests were performed on the curvature of growth trajectories, with Bonferroni correction. Results: A total of 14 opsoclonus-myoclonus ataxia syndrome patients (12 female) and 474 healthy control children (406 female) were included. Curvature of the growth trajectories of the cerebral white and gray matter, cerebellar white and gray matter, and brainstem differed significantly between opsoclonus-myoclonus ataxia syndrome patients and healthy control children (cerebral white matter, P =.01; cerebral gray matter, P =.01; cerebellar white matter, P <.001; cerebellar gray matter, P =.049; brainstem, P <.01). Discussion/Conclusion: We found abnormal brain maturation in the supratentorial brain, brainstem, and cerebellum in children with opsoclonus-myoclonus ataxia syndrome. [ABSTRACT FROM AUTHOR]

IgA vasculitis (IgAV), formerly known as Henoch–Scholein purpura, is a small vessel vasculitis, most commonly seen in pediatric patients, that can affect numerous internal organs including the kidneys, lungs, gastrointestinal tract, and the central nervous system (CNS). CNS manifestations of this condition include hypertensive encephalopathy, thrombosis, optic neuropathy, seizures, CNS vasculitis, and a more recently described phenomenon known as posterior reversible encephalopathy syndrome (PRES). Symptoms of PRES include hypertension, altered mental status, and seizures caused by vasogenic disruption of the blood–brain barrier, and the condition is diagnosed by characteristic edema‐related gray–white matter changes in the parieto‐occipital lobes on magnetic resonance imaging. Herein, we present a rare case of PRES as a presenting sign of IgAV to increase awareness about this unusual association. [ABSTRACT FROM AUTHOR]

Background: Though epileptic seizures are common in posterior reversible encephalopathy syndrome (PRES), status epilepticus (SE) as the presenting feature is rare. Objective: To study the clinical spectrum and outcome of patients with SE as presenting feature of PRES. Methods: This is a retrospective study. PRES was diagnosed based on the clinical features and imaging findings on brain MRI (n = 40) which became normal after 6 months follow-up imaging. Patients with SE as the initial manifestation of PRES were identified. Baseline information regarding the clinical presentation, etiology, past history of illness, treatment history, imaging findings, EEG and long-term clinical outcome. Result: Seizure was the most common presentation seen in 31 patients (77.5%). The etiologies in PRES were preeclampsia, or eclampsia [n = 33 (82.5%)], hypertensive encephalopathy [n = 3 (7.5%)], systemic lupus erythematosus (SLE), AIP, and chronic renal failure (CRF) in one patient each [n = 01 (2.5%)]. Brain MRI showed the involvement of parieto-occipital lobes (n = 33 [82.5%]) mostly. Status epilepticus (generalized convulsive) was the presenting feature in eight cases (20%). Among them, five cases (0.5%) had a history of chronic epilepsy. In the remaining three patients, SLE and acute intermittent porphyria, CRF precipitated the SE. Conclusion: The study highlights the clinico-etiological spectrum of PRES and the identification of SE within its context leading to the early diagnosis and management if treated early. The role of antenatal care is important for the identification and treatment of etiologies, blood pressure, proper antiepileptic drug compliance and appropriate counseling. [ABSTRACT FROM AUTHOR]

Hypertensive crisis is rare in children. Among the rarest causes leading to this acute crisis, is bilateral adrenal tumour as a part of a syndrome, Von Hippel Lindau syndrome. The treatment is based on the excision of the adrenal tumour followed by long term surviellence. The authors present a case where conventional imaging with ultrasound and contrast enhanced CT scan demonstrated a right side adrenal tumour with raised catecholamines.The small left side tumour got missed on conventional imaging and got picked up on DOTA scan. The persistence of hypertension in post operative period can be related to such hidden functioning tumours. In view of the size of tumour & raised dopamine associated with high incidence of malignancy, robotic surgery was used for bilateral adrenal tumour excision which confirmed the diagnosis of Pheochromocytoma (PCC). [ABSTRACT FROM AUTHOR]

Aim. To study brain magnetic resonance imaging (MRI) changes in patients with resistant hypertension (HTN) after renal denervation (RD) and its cerebral protection effectiveness.Material and methods. The study included 111 patients, of whom 50 were men (45%) and 61 were women (55%), who underwent RD. The mean number of antihypertensive drugs taken regularly was 4,1±1,1. All patients underwent brain MRI and 24-hour ambulatory blood pressure monitoring before and after renal denervation. The data were statistically processed using Statistica 10,0 software.Results. After RD, a pronounced antihypertensive effect was observed with a significant reduction in systolic and diastolic blood pressure by 10,3/5,5 and 13,1/7,3 mm Hg at 6 and 12 months, respectively. Office blood pressure, daytime, and nighttime blood pressure levels also decreased (p0,05).Conclusion. RD contributes to a significant decrease in blood pressure levels and exerts a cerebral protective effect by reducing lateral brain ventricles, subarachnoid spaces, and absence of ischemia progression and intracranial hypertension after intervention.

Pheochromocytomas and paragangliomas are rare tumors. A 10 year‐old girl was brought to the emergency room with complaints of sudden vomiting and convulsions, and was initially diagnosed with hypertensive encephalopathy. Magnetic resonance imaging and computed tomography scan showed a large mass (6 × 3 × 3 cm) on the dorsal side of the inferior vena cava, surrounded by the right diaphragmatic crus, and closely attached to the aorta. Blood noradrenaline, urinary normetanephrine, and noradrenaline levels were elevated. The final diagnosis was retroperitoneal paraganglioma, then, surgery was contemplated. The location of the liver and great vessels in front of the tumor made the commonly performed transabdominal approach complicated. Therefore, retroperitoneoscopic surgery was preferred for safer resection, with better visualization in a sufficient space with less risk of damaging the surrounding organs. The retroperitoneoscopic approach is a good indication for tumors located behind the great vessels. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is characterized by transient vasogenic edema predominantly in supratentorial areas within the posterior circulation regions. Although PRES with only brainstem involvement is quite rare, accurate diagnosis is important because prompt antihypertensive therapy contributes to a favorable outcome. Herein, we report a case with isolated brainstem PRES showing dramatical improvement in an apparent diffusion coefficient (ADC) value of the lesion in magnetic resonance imaging (MRI) after clinical remission. The present case suggests the association between favorable clinical course and complete amelioration on MRI. [ABSTRACT FROM AUTHOR]

Background: Haematopoietic stem cell transplantation (HSCT) is used worldwide in various malignant and nonmalignant childhood diseases, including haematologic, genetic, autoimmune and metabolic disorders, and is the only curative treatment for many of these illnesses. The survival rates of many childhood diseases have been increased due to HSCT treatment. However, associated complications are still important for management. Central nervous system (CNS) complications in paediatric HSCT recipients can be associated with high morbidity and significantly contribute to mortality. Posterior reversible encephalopathy syndrome (PRES) is one of the most common CNS complications in patients with neurological symptoms following HSCT. Magnetic resonance imaging (MRI) is the modality of choice and shows typical bilateral vasogenic oedema at the posterior parts of the cerebral hemispheres; however, various atypical imaging manifestations can also occur. In this study, we retrospectively examined CNS complications in our paediatric HSCT recipients with a focus on the typical and atypical neuroimaging manifestations of PRES following HSCT.Methods: We retrospectively reviewed the medical records of 300 consecutive paediatric HSCT recipients from January 2014 to November 2018. A total of 130 paediatric HSCT recipients who experienced neurological signs and symptoms and were evaluated with neuroimaging studies following HSCT were enrolled in the study. The timing of CNS complications was defined according to immune status, including the pre-engraftment period (< 30 days after HSCT), the early postengraftment period (30-100 days after HSCT), and the late postengraftment period (> 100 days after HSCT), which were defined as phases 1, 2 and 3, respectively.Results: Overall, 130 paediatric HSCT recipients experienced neurological signs and symptoms and therefore underwent neuroimaging examinations. Among these 130 patients, CNS complications were present in 23 patients (17.6%, 23/130), including 13 (56.5%) females and 10 (43.5%) males with a median age of 8.0 years (range, 8 months to 18.0 years). Among these 23 patients, 14 cases of PRES (60.9%), 5 (21.7%) cases of leukoencephalopathy, 3 cases of acute subdural haemorrhage (ASDH) (13%) and 1 (4.3%) case of fungal CNS infection were identified by neuroimaging. On MRI, typical parietooccipital vasogenic oedema was present in 78.5% of the PRES cases (11/14). The following atypical neuroimaging manifestations were observed: isolated involvement of the bilateral frontal lobes in 1 case, isolated cerebellar vermis involvement in 1 case, and isolated basal ganglia involvement in 1 case. Restricted diffusion associated with cytotoxic damage was demonstrated in 2 of 14 cases, one of which also showed subacute cytotoxic injury with ADC pseudonormalization.Conclusion: Paediatric HSCT recipients presenting with CNS signs and symptoms should be evaluated by neuroimaging studies for timely diagnosis and early management. PRES is the most common CNS complication and may present with atypical MRI manifestations, which should not dissuade a PRES diagnosis in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

Reports of different types of neurological manifestations of COVID-19 are rapidly increasing, including changes of posterior reversible leukoencephalopathy syndrome (PRES). Here we describe the first reported case of COVID-19 and PRES in Australia diagnosed on basis of MRI brain imaging and confirmed clinically by presence of confusion, delirium, headaches, also associated with hypertension and blood pressure variability and stable long-term kidney problems. He made full recovery as his blood pressure was controlled and clinical status was supported with appropriate supportive therapy. Although traditionally a rare condition, PRES is likely to be more common among patients with COVID-19 pathobiology there is Renin downregulation of ACE2 receptors, involvement of Renin-Angiotensin-Aldosterone system, endotheliitis, cytokine storm, and hyper-immune response. Thus we advocate clinical suspicion and early brain imaging with MRI brain among vulnerable patients with known co-morbidities, and diagnosed with COVID-19 given that hypertension and blood pressure variability are often exacerbated by acute SARS-CoV-2 immune reactions. Such acute hypertensive encephalopathy was able to be reversed with timely supportive therapy ensuring re-hydration and re-establishment of blood pressure control. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a risk factor for posterior reversible encephalopathy syndrome (PRES), but the timing and severity of hypertension relative to PRES are unknown. The objective was to identify a clinically meaningful blood pressure (BP) threshold that predicts PRES development in high-risk children. Methods: We recorded peak systolic BP, diastolic BP, BP z-scores, and mean arterial pressure over the 14 days preceding clinical concern for PRES in 35 subjects who developed PRES, compared to 14 controls who had normal brain magnetic resonance imaging and similar underlying disease, renal function, and medications. We used multivariable logistic regression models adjusted for fluid overload and obesity to estimate the association of peak BP with PRES. We used receiver operating characteristic curves to determine which peak BP thresholds best predicted PRES and calculated the corresponding sensitivity, specificity, and positive and negative predictive values. Results: Peak systolic BP z-score was most strongly associated with PRES (OR 3.97, 95% CI 1.62–9.74), and peak systolic BP z-score ≥ 3.0 predicted PRES (area under the curve 0.95, 95% CI 0.88–1.0) with 91% sensitivity and 85% specificity, indicating 94% positive predictive value and 79% negative predictive value. Conclusions: We demonstrated that peak systolic BP z-score ≥ 3.0 in the preceding 14 days predicted PRES development in cases compared with controls in children at high risk. Our study suggests that stage 2 hypertension, corresponding to a z-score ≥ 3.0, could help define hypertensive emergency in high-risk children and indicate when more aggressive treatment is warranted to prevent neurologic injury. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome that presents as transient cerebral edema (vasogenic edema), usually on a background of hypertensive encephalopathy, puerperal eclampsia, or immunosuppressant drug use. We describe a case of PRES that arose in the context of a psychiatric disorder. The patient was a 26-year-old woman with schizophrenia who was hospitalized upon falling into a catatonic stupor and then suffered acute anxiety leading to impulsive polydipsia and subsequent water intoxication. She lost consciousness, and brain magnetic resonance imaging revealed a high density area, primarily affecting the cortex and subcortical white matter in areas in the occipital and parietal lobes, leading to the diagnosis. We did not treat the hyponatremia by means of aggressive sodium supplementation but rather balanced the extracellular fluid by continuous infusion of isotonic electrolyte replacement fluid. The patient's level of consciousness improved gradually, but a total 141 days passed before hospital discharge was appropriate. The prognosis for PRES is generally favorable, but irreversible neurological damage can occur. We believe, therefore, that brain magnetic resonance imaging should be performed promptly whenever PRES is suspected and that timely, appropriate treatment is of utmost importance. If PRES is observed in a psychiatric patient, it is important to investigate whether the condition might have been caused by water intoxication and to treat the condition accordingly. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological condition that involves the acute onset of headache, confusion, optical impairments, and seizures with accompanying vasogenic edema on brain imaging. PRES is a complex disorder with many causative factors, including underlying conditions such as hypertensive encephalopathy, eclampsia, collagen disease, and severe infection. Although the exact pathophysiological mechanism is not completely understood and remains controversial, the predominant proposed mechanism is endothelial dysfunction, which is preceded by hypertension, immunosuppressive agents, or cytotoxic medication. Magnetic resonance imaging (MRI) facilitates prompt diagnosis and treatment and leads to good outcomes. Findings are characterized by the following: hyperintensity on fluid-attenuated inversion recovery images and apparent diffusion coefficient mapping, and isointensity on diffusion weighted images involving the parieto-occipital or posterior frontal cortical–subcortical regions that are recognized in >90% of patients, and reversibility of neuroimaging abnormalities, with the latter being the most important. As an algorithm to standardize the diagnosis of PRES has not yet been developed, this review presents a diagnostic algorithm based on the types of MRI findings. This algorithm may provide a better understanding of the characteristics that compose PRES and bring us one step closer to the standardization of PRES diagnosis, helping clinicians evaluate individual features while also considering competing differential diagnoses. • Typical MRI findings of PRES in parieto-occipital lobes caused by vasogenic edema. • Atypical PRES cases show brainstem, basal ganglia, and cerebellum. • Endothelial dysfunction may be the predominant pathophysiological mechanism of PRES. • MRI findings have been useful for the prompt diagnosis of PRES. • MRI findings play a central role in constructing the algorithm. [ABSTRACT FROM AUTHOR]

Sepsis-associated encephalopathy (SAE) contributes to mortality and neurocognitive impairment of sepsis patients. Neurofilament (Nf) light (NfL) and heavy (NfH) chain levels as biomarkers for neuroaxonal injury were not evaluated in cerebrospinal fluid (CSF) and plasma of patients with sepsis-associated encephalopathy (SAE) before. We conducted a prospective, pilot observational study including 20 patients with septic shock and five patients without sepsis serving as controls. The assessment of SAE comprised a neuropsychiatric examination, electroencephalography (EEG), magnetic resonance imaging (MRI) and delirium screening methods including the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). CSF Nf measurements in sepsis patients and longitudinal plasma Nf measurements in all participants were performed on days 1, 3 and 7 after study inclusion. Plasma NfL levels increased in sepsis patients over time (p = 0.0063) and remained stable in patients without sepsis. Plasma NfL values were significantly higher in patients with SAE (p = 0.011), significantly correlated with the severity of SAE represented by ICDSC values (R = 0.534, p = 0.022) and correlated with a poorer functional outcome after 100 days (R = -0.535, p = 0.0003). High levels of CSF Nf were measured in SAE patients. CSF NfL levels were higher in non-survivors (p = 0.012) compared with survivors and correlated with days until death (R = -0.932, p<0.0001) and functional outcome after 100 days (R = -0.749, p<0.0001). The present study showed for the first time that Nf levels provide complementary prognostic information in SAE patients indicating a higher chance of death and poorer functional/cognitive outcome in survivors. [ABSTRACT FROM AUTHOR]

Background. Posterior reversible encephalopathy syndrome (PRES) is characterized by a variable association of symptoms including headache, consciousness impairment, visual disturbances, seizures, and focal neurological signs. Treating the underlying cause usually leads to partial or complete resolution of symptoms within days or weeks. Brain MRI findings include hyperintensities on T2-weighted sequences and their reversibility on follow-up exams. We describe two patients, one with an atypical clinical presentation characterized by a severe and prolonged impairment of consciousness and the other with atypical neuroimaging findings. Case Presentation. The first patient was a 42-year-old woman, with a negative medical history, presenting with seizures, lethargy, and left hemiparesis, 60 hours after uncomplicated delivery. Brain MRI showed an atypical pattern of alterations, with patchy asymmetric distribution in all lobes. Symptoms completely resolved after twelve days. The second patient was a 59-year-old woman with a history of hypertension, presenting with severe impairment of consciousness, vision loss, and seizures. Symptoms partially resolved after three weeks. Conclusion. PRES is characterized by reversible symptoms and radiological findings. Brain MRI usually shows widespread oedema in white matter with typical patterns. The cases we described suggest that PRES may presents with atypical symptoms and radiological manifestations, mimicking other neurological conditions. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome is characterized by acute headache, visual impairment, seizures, and altered mental status; neuroimaging may show cerebral edema affecting the parietal and occipital lobes of the brain. The objective of this article is to review the current understanding of posterior reversible encephalopathy syndrome in eclampsia. Literature was searched from PubMed, Scopus, and Google Scholar databases. The search terms included "eclampsia", "eclampsia and posterior reversible encephalopathy syndrome", and "pregnancy and posterior reversible encephalopathy syndrome". We reviewed all published original articles with the search term "posterior reversible encephalopathy syndrome". Up to 100% of eclamptic patients may have reversible posterior leukoencephalopathy syndrome. Two putative mechanisms - "vasogenic" and "vasospasm" - are considered to be responsible. Cerebral edema and petechial cortical hemorrhages are common autopsy findings. Clinical and neuroimaging manifestations are reversible in the majority of patients. Prompt correction of increased blood pressure and treatment of seizures are the cornerstones of treatment. Magnesium sulfate is the drug of choice for seizures. Some survivors may have permanent vision loss and other disabling sequelae. In conclusion, posterior reversible encephalopathy is a devastating complication of eclampsia. Early recognition helps in preventing some of its devastating sequelae. [ABSTRACT FROM AUTHOR]

The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits. In a majority of patients the clinical presentation includes elevated arterial blood pressure up to hypertensive emergencies. Neuroimaging, in particular magnetic resonance imaging, frequently shows a distinctive parieto-occipital pattern with a symmetric distribution of changes reflecting vasogenic edema. PRES frequently develops in the context of cytotoxic medication, (pre)eclampsia, sepsis, renal disease or autoimmune disorders. The treatment is symptomatic and is determined by the underlying condition. The overall prognosis is favorable, since clinical symptoms as well as imaging lesions are reversible in most patients. However, neurological sequelae including long-term epilepsy may persist in individual cases. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. Methods: We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renalorigin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups. Results: The renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05). Conclusion: We conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) characteristically presents with rapid onset of headache, seizure, encephalopathy, and visual changes, along with evidence of parieto-occipital vasogenic edema on magnetic resonance imaging. We describe the case of a 41-year-old female with a protracted presentation of two of the four classic PRES symptoms, which were not immediately recognized as PRES due to the presence of multiple other comorbidities and reasons for encephalopathy. This case highlights the possibility of atypical presentations of PRES and the diagnostic challenges in making this clinical diagnosis when competing diagnoses are present. [ABSTRACT FROM AUTHOR]

Epilepsy outcomes after therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy are understudied. The authors used multivariable logistic regression to predict epilepsy in neonates after selective head cooling. Sensitivity analyses used magnetic resonance imaging (MRI) and electroencephalogram (EEG) interpretations by different clinicians. Fifty neonates had 2-year follow-up. Nine developed epilepsy. Predictors included pH ≤6.8 on day of birth (adjusted odds ratio [OR] 19 [95% confidence interval (CI) 1-371]), burst suppression on EEG on day 4 (8.2 [1.3-59]), and MRI deep gray matter injury (OR 33 [2.4-460]). These factors stratify neonates into low (0-1 factors; 3% [0%-14%] risk), medium (2 factors; 56% [21%-86%] risk), and high-risk groups (3 factors; 100% [29%-100%] risk) for epilepsy. The stratification was robust to varying clinical interpretations of the MRI and EEG. Neonates with hypoxic-ischemic encephalopathy who undergo selective head cooling appear at risk of epilepsy if they have 2 to 3 identified factors. If validated, this rule may help counsel families and identify children for close clinical follow-up. [ABSTRACT FROM AUTHOR]

The article reports on a study conducted on patients of hospital in Pakistan suffering from posterior reversible encephalopathy syndrome (PRES) using magnetic resonance imaging (MRI). Topics discussed include lesion distribution on imaging with MRI in patients, syndrome's effects on posterior part of brain with basal ganglia, brain stem and cerebellum; and its neurotoxic state of causing permanent neurological deficits and even death if delaying in diagnosis.

Propósito: Realizar una revisión del síndrome de leucoencefalopatía posterior reversible, destacando los hallazgos imagenológicos atípicos del mismo. Materiales y métodos: Se estudiaron retrospectivamente 10 casos (n=10), 6 mujeres y 4 varones con edades comprendidas entre 7 y 84 años (media 40.6 años), con un tomógrafo multicorte (Siemens Sensation 16, Erlangen, Germany) y dos resonadores (Magnetom Symphony 1.5T y Magnetom Impact 1T) entre octubre del año 2000 y mayo del 2007. Resultados: En nuestra casuística, el 40% (n=4) de los pacientes presentó edema citotóxico (hiperintensidad en Difusión); el 70% (n=7), compromiso del circuito anterior; el 20% (n=2) presentó sangrado, y el 10% (n=1), afectación del tronco del encéfalo. Conclusión: En la mayoría de los pacientes con diagnóstico de leucoencefalopatía posterior reversible se evidencia señal hiperintensa en secuencias T2 y FLAIR en la sustancia blanca de lóbulos occipitales y parietales, sin representación en la secuencia de difusión. Sin embargo, puede afectar otros territorios, presentar edema citotóxico, hemorragia y no ser reversible. Estos hallazgos atípicos conllevan un peor pronóstico y por ende una mayor mortalidad. Un adecuado análisis de las imágenes es importante para confirmar la sospecha clínica y establecer una terapéutica precoz.Purpose: To make a review of the Posterior Reversible Leukoencephalopathy Syndrome making emphasis on atypical imaging findings. Materials and methods: Ten patients (n:10) were studied retrospectively, six of them women and four men of ages between seven and eighty four (mean age: 40.6). The exams were performed with a multislice CT scanner (Siemens Sensation 16, Erlangen, Germany) and two MRI units (Magnetom Symphony 1.5T and Magnetom Impact 1T, Erlangen, germany) between October 2000 and May 2007. Results: Out of ten (n=10) patients evaluated, 40% (n= 4) presented citotoxic edema (DWI hyperintensity), 70% (n= 7) compromise of the anterior circulation, 20% (n= 2) showed haemorrhage, and 10% (n= 1) brainstem involvement. Conclusion: Usual findings in Posterior Reversible Leukoencephalopathy are bilateral T2 and FLAIR hyperintensity in occipital and parietal white matter, without abnormalities in DWI. However, in some cases, other territories can be affected, citotoxic edema or haemorrhage may be present and the affection can be irreversible. These atipical findings are associated with a worse outcome and grater mortality. An appropiate imaging analysis is important to confirm clinical presumption and establish an early therapy.

Purpose This study aims to apply neurite orientation dispersion and density imaging (NODDI) to measure white matter microstructural features during early development. Methods NODDI parameters were measured in twelve newborns and thirteen 6-month infants, all with perinatal clinical encephalopathy. Results Between 0 and 6 months, there were significant differences in fractional anisotropy (FA) for all tracts; in neurite density for internal capsules, optic radiations, and splenium; and in orientation dispersion for anterior limb of internal capsule and optic radiations. There were no appreciable differences in NODDI parameters related to outcome. Conclusion NODDI may allow more detailed characterization of microstructural maturation than FA. [ABSTRACT FROM AUTHOR]

Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a relatively rare syndrome of reversible encephalopathy and could be divided into two subtypes of inflammatory CAA (ICAA) and amyloid-β-related angiitis (ABRA) according to histopathology. We present a case of pathologically proved ABRA with partial seizures and headache, and a focal lesion in the right temporal lobes on magnetic resonance imaging. Summarized from previous 139 ABRA and ICAA cases, ABRA is preferred when the lesion is enhanced on MRI and requires combination drug therapy, while ICAA is highly suspected with ApoE genotype of ɛ4/ɛ4. More clinical markers for diagnosis of CAA-ri warrant further researches. [ABSTRACT FROM AUTHOR]

Introduction: Hashimoto’s encephalopathy is a condition associated with dysthyroidism and other autoimmune diseases. The pathophysiology is unclear and clinically the disease is characterized by neurological and psychiatric alterations in absence of brain infection. Antithyroid antibodies are high and imaging studies may be normal. Corticosteroid therapy is the treatment of choice. Case report: A 36-year-old woman with monoparesis, behavior and personality changes and hyperthyroidism. Lumbar puncture was done and infectious, metabolic and neoplastic encephalopathy causes were ruled out. MRI skull was requested, it reports compatible images with various brain abscesses of undetermined origin. Considering a probable Hashimoto encephalopathy, anti-peroxidase and thyroglobulin antibodies were requested, detecting high titers. Corticosteroids and immunoglobulin scheme were started with a poor response to the treatment. Conclusions:This case associated Hashimoto’s encephalopathy with hyperthyroidism, a rare association reported in the literature. It was suspected a CNS primary vasculitis due to high values of complement, however, brain biopsy was not performed to define a more accurate diagnosis. [ABSTRACT FROM AUTHOR]

A 16-year-old female spayed English Staffordshire terrier was presented for evaluation of a 10-month history of intermittent myoclonic episodes, and a one weeks history of short episodes of altered mentation, ataxia and collapse. Magnetic resonance imaging identified subcortical oedema, predominately in the parietal and temporal lobes and multiple cerebral microbleeds. Serum biochemistry, indirect blood pressure measurements and magnetic resonance imaging abnormalities were consistent with hypertensive encephalopathy secondary to chronic kidney disease. [ABSTRACT FROM AUTHOR]

Introduction HELLP syndrome (acronym comprised of hemolysis, elevated liver enzymes and low platelets) is seen in 0.1% of pregnant women. Posterior reversible encephalopathy syndrome (PRES) was reported to be 5% in patients with the HELLP syndrome. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI. Aim We aimed to improve clinicians’ perception about brain lesions in the HELLP syndrome with imaging findings. Case study Here, we present a case of an 18-year-old patient with a pregnancy of 24 weeks admitted with HELLP syndrome, with CT and MRI findings of PRES and intracerebral hematoma. MRI scan of the brain showed vasogenic edema in the occipital, frontal and parietal lobes bilaterally, basal ganglia and brainstem. An emergency cesarean section was successfully performed to end the pregnancy on the same day. Repeat MRI of the brain three days after initial admission showed partial improvement of the previous abnormalities with full clinical recovery. Results and discussion The patient in this report had a variant form of PRES where the pathologic process encompassed both the posterior and anterior circulations. Conclusions An appropriate multidisciplinary approach is the key for reducing the morbidity and mortality of PRES syndrome. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome (PRES) is a potentially devastating neurologic syndrome, but timely treatment may lead to complete reversal of the disease course. We reviewed 12 cases of PRES and describe the clinical history and imaging findings, including conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and calculated apparent diffusion coefficient (ADC) maps, used to establish the diagnosis of PRES. Three male and nine female patients aged between 11 and 70 years (mean, 37 years) with clinical and imaging findings consistent with PRES were enrolled in the study. All patients had undergone conventional MRI and 10 had undergone additional DWI studies. Ten patients had follow-up MRI studies. DWI was performed using a 1.5T system with a single-shot spin-echo echo-planar pulse sequence. Initial and follow-up neuroimaging and clinical history were reviewed. Lesions were almost always present over the posterior circulation, mainly the parieto-occipital region, affecting primarily the white matter. The anterior circulation region, brainstem, cerebellum, deep cerebral white matter, and thalamus were also involved in five cases. Conventional MRI revealed hyperintensity on T2- weighted and fluid-attenuated inversion recovery images. DWI showed isointensity and increased signal intensity on ADC values in all cases, indicating vasogenic edema. Clinical and MRI follow-up showed that the symptoms and radiologic abnormalities could be reversed after appropriate treatment of the causes of PRES in most patients (9 of 10). In one patient, the ADC value was lower on follow-up images, indicating cytotoxic edema with ischemic infarct. DWI was a useful complement to MRI in the diagnosis of PRES.

Objective To report the incidence and findings of brain magnetic resonance imaging (MRI) in patients with hemorrhagic fever with renal syndrome (HFRS)-related encephalopathy along with its clinical course. Methods Medical records and brain MRI were reviewed from January 2004 to January 2013. The final cohort consisted of 145 patients. Brain MRI findings were correlated with associated clinical stage of disease. Results The MRI findings associated with clinical course of HFRS-related encephalopathy were posterior reversible encephalopathy syndrome pattern ( n = 3) in oliguric phase and splenial lesion pattern ( n = 1) in febrile phase. Conclusions Brain MRI findings in HFRS-related encephalopathy may be associated with the clinical course of HFRS. [ABSTRACT FROM AUTHOR]

Background Posterior reversible encephalopathy syndrome (PRES) is a serious and increasingly recognized disorder in humans. However, isolated cerebellar involvement in PRES is extremely uncommon. In this study, we sought to investigate its clinical and radiological features by describing a cohort of cases with PRES and isolated cerebellar involvement. Methods We report 2 patients with PRES with only cerebellar involvement and identified additional 9 cases using the PubMed database with the MeSH terms “posterior reversible encephalopathy syndrome”, “hypertensive encephalopathy”, “hypertension”, “cerebellum”, “encephalopathy”, and “magnetic resonance imaging”. We then collectively analyzed the clinical and imaging characteristics of these 11 cases. Results The average age was 28 years, with 8 male and 3 female patients. All cases had severe acute hypertension and T2 hyperintensity on MRI exclusively centered within the cerebellum. Of 11 patients, 7 had hypertensive retinopathy, a favorable clinical course with only antihypertensive treatment, and resolution of the cerebellar lesions on follow-up imaging. A total of 5 of the 11 patients received external ventricular drainage due to obstructive hydrocephalus and only 2 of the 11 had a seizure. Conclusions Isolated cerebellar involvement in PRES may be a unique variant that affects younger, male cases with severe acute hypertension and hypertensive retinopathy, but not necessarily seizure. Most patients have full recovery after fast control of blood pressure. Awareness of atypical neuroimaging features in PRES is critical for appropriate treatment. [ABSTRACT FROM AUTHOR]

Aim The optimal timing of magnetic resonance imaging ( MRI) in encephalopathic infants treated with hypothermia is unknown, and this study examined whether early scans differed from later scans. Methods We assessed paired MRI scans carried out on 41 cooled encephalopathic infants at a median of four and 11 days using two scoring systems: the Rutherford injury scores for the basal ganglia and thalami ( BGT), white matter and the posterior limb of the internal capsule, and the Bonifacio injury scores for the BGT and watershed area. Results Both systems produced consistent injury severity scores in 37 of 41 infants on both days, with Rutherford scores predicting poor outcome in six early scans and seven later scans (K = 0.91) and Bonifacio doing the same in seven and nine scans (K = 0.85). A white matter/watershed score of two or a BGT score of one indicated severe changes by day 11 in three infants, but lower scores did not. Conclusion Magnetic resonance imaging scans indicated that the Rutherford and Bonifacio systems produced similar scores in 37 of 41 cooled encephalopathic infants at a median of four and 11 days. Infants with an early white matter/watershed scores of two or a BGT score of one may worsen and should be rescanned. [ABSTRACT FROM AUTHOR]

Aims To determine the correlation between amplitude-integrated electroencephalogram ( aEEG) background pattern and cerebral magnetic resonance imaging ( MRI) in infants with hypoxic-ischaemic encephalopathy ( HIE) and to examine whether the correlation changes with therapeutic hypothermia. Methods We included 38 term-born infants with HIE of whom 17 were cooled. All were continuously monitored with aEEG. Background pattern was scored at the beginning and the end of the recording. Cerebral MRI was obtained on median day 5 (2-11 days). Abnormalities were classified using a predefined scoring system for basal ganglia, watershed and overall injury, and then grouped into mild-moderate and severe. Results Abnormal aEEG background pattern correlated with more severe cerebral injury on MRI in the non-cooled infants ( P < 0.01). In addition, cooled infants had less severe cerebral injury than non-cooled infants, in particular on T2-weighted images (watershed P = 0.04 and total injury score = 0.07). Conclusions Abnormal aEEG background pattern is predictive of abnormal MRI, but therapeutic hypothermia seems to reduce this association. Thus, when cooling is applied in a clinical setting, the predictive value of aEEG may be limited. [ABSTRACT FROM AUTHOR]

Introduction. Eclampsia is one of the most serious complications of hypertensive disorders of pregnancy, defined as the occurrence of one or more convulsions superimposed on preeclampsia. Besides the ordinary course of the disease, ranging from a mild to a severe form, with culmination in eclamptic seizures, there is a significant percent of cases where eclampsia starts unexpectedly, without typical premonitory symptoms and signs, which makes it difficult to prevent. Neuroradiological Characteristics and Pathogenesis of Eclampsia. Neuroradiological signs of eclampsia are described as posterior reversible encephalopathy syndrome, and are manifested by nausea, vomiting, headache, visual disturbances, altered mental status, convulsions and coma, together with characteristic findings on computed tomography or magnetic resonance imaging scan of the head, indicating the presence of vasogenic brain edema. The topic of this article are possible mechanisms of the development of posterior reversible encephalopathy syndrome in pregnancy and modalities of acute treatment of this emergency state. Management of Eclampsia. Magnesium sulphate is nowadays the drug of choice for the treatment and prevention of eclamptic seizures. Labetalol is considered to be the agent of choice in the treatment of hypertensive emergencies of pregnancy, followed by hydralazine, nifedipine, nicardipine, urapidil, nitroglycerin and sodium nitroprusside (in most refractory cases). Angiotensin converting enzyme inhibitors and angiotensin blocking drugs are contraindicated in pregnancy. Captopril and enalapril are allowed during lactation. Conclusion. Posterior reversible encephalopathy syndrome in eclamptic patients is completely reversible if adequate diagnosis is promptly made and intensive treatment immediately administered. [ABSTRACT FROM AUTHOR]

Diabetic myonecrosis is a rare and underdiagnosed complication of long-standing, uncontrolled diabetes. It usually occurs in patients with long-standing diabetes in the presence of microvascular complications. Thigh muscles are more commonly affected and the usual presentation is thigh swelling with or without pain, systemic features being rare. Magnetic resonance imaging is the gold standard for diagnosis. Most patients recover spontaneously with bed rest, adequate analgesia and good glycemic control. We present a case of recurrent myonecrosis of adductor muscles of the thigh in a patient with long standing type 2 diabetes mellitus who recovered with conservative management. [ABSTRACT FROM AUTHOR]

Moderate to severe neonatal hypoxic ischemic encephalopathy remains an important cause of infant death and childhood disability. Early and accurate diagnosis of encephalopathy is difficult but critical for timely intervention. Thus, we have utilized a clinically relevant large animal model of asphyxia in-utero, followed by immediate lamb delivery, resuscitation and clinical care over the next 72 h for assessment of potential biomarkers of brain injury. In-utero asphyxia was induced in twelve near-term lambs and outcomes compared with seven controls. Asphyxia resulted in bradycardia (97 ± 12 beats/min), hypotension (12.1 ± 1 mm Hg) and metabolic acidosis (pH 6.9 ± 0.02; base-excess − 13.8 ± 0.8 mmol/l). 72 h following asphyxia, cerebrospinal concentrations of malondialdehyde and S100B were elevated 2-fold and 5-fold, respectively, in asphyxic lambs compared to control lambs. Magnetic resonance spectroscopy (MRS) at 72 h showed a significant decrease in n-acetyl aspartate: choline ratio in asphyxia lambs compared to that observed at 12 h (0.56 ± 0.23 vs. 0.82 ± 0.15, respectively); lactate:choline ratio was not changed over this time. Marked neuropathology was observed in asphyxia lambs with neuronal degeneration in the hippocampus, thalamus, striatum and cortex. Astrogliosis was observed in the hippocampus and thalamus. Early blood markers of metabolic state showed limited predictive value of histological damage at 72 h. MRS outcomes at 72 h showed a modest but significant correlation with histological evidence of neuronal brain injury (lactate:N-acetyl aspartate ratio in the thalamus r 2 = 0.2, p < 0.01). MRS at 72 h was best able to detect established brain injury, but a combination of biomarkers over multiple phases of injury may be able to assess the evolution of neonatal brain injury. [ABSTRACT FROM AUTHOR]

Background: The diagnostic and prognostic assessment of newborn infants with hypoxic-ischemic encephalopathy (HIE) comprises, among other tools, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps. Objective: To compare the ability of DWI and ADC maps in newborns with HIE to predict the neurodevelopmental outcome at 2 years of age. Materials and methods: Thirty-four term newborns with HIE admitted to the Neonatal Intensive Care Unit of Modena University Hospital from 2004 to 2008 were consecutively enrolled in the study. All newborns received EEG, conventional MRI and DWI within the first week of life. DWI was analyzed by means of summation (S) score and regional ADC measurements. Neurodevelopmental outcome was assessed with a standard 1-4 scale and the Griffiths Mental Developmental Scales - Revised (GMDS-R). Results: When the outcome was evaluated with a standard 1-4 scale, the DWI S scores showed very high area under the curve (AUC) (0.89) whereas regional ADC measurements in specific subregions had relatively modest predictive value. The lentiform nucleus was the region with the highest AUC (0.78). When GMDS-R were considered, DWI S scores were good to excellent predictors for some GMDS-R subscales. The predictive value of ADC measurements was both region- and subscale-specific. In particular, ADC measurements in some regions (basal ganglia, white matter or rolandic cortex) were excellent predictors for specific GMDS-R with AUCs up to 0.93. Conclusions: DWI S scores showed the highest prognostic value for the neurological outcome at 2 years of age. Regional ADC measurements in specific subregions proved to be highly prognostic for specific neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome is a clinicoradiological entity characterized clinically by headache, hypertension, altered sensorium and visual disturbances. It is usually seen in the setting of toxemia of pregnancy, hypertension, severe infection or in patients receiving immunosuppressant's. The magnetic resonance imaging of the brain in such patients reveals bilateral symmetrical subcortical edema in the occipitoparietal region. The treatment is primarily supportive and involves removing the underlying cause. The condition if not identified in time may lead to irreversible damage to the brain such as hemorrhage or infarction. [ABSTRACT FROM AUTHOR]

Therapeutic hypothermia has become standard treatment for neonatal hypoxic-ischemic encephalopathy (HIE), with brain MRI commonly performed after the child has been rewarmed. However, early imaging during hypothermia might provide information important in designing clinical trials that refine and personalize therapeutic hypothermia. We tested a protocol to ensure safety and maintenance of hypothermia during in-hospital transport and MRI. MRI during therapeutic hypothermia was performed in 13 newborns on the 2nd-3rd postnatal days. Mean one-way transport time was 20.0 ± 3.3 min. Mean rectal temperatures (°C) leaving the unit, upon arrival at the MR suite, during MRI scan and upon return to the unit were 33.5 ± 0.3°C, 33.3 ± 0.3°C, 33.1 ± 0.4°C and 33.4 ± 0.3°C, respectively. Using our protocol therapeutic hypothermia was safely and effectively continued during in-hospital transport and MRI without adverse effects. [ABSTRACT FROM AUTHOR]

This paper reports findings froma feline case of hippocampal necrosis.Aseven-year-old neutered female cat was seen with a history of behavioural change followed by complex focal seizures. The cat was severely pyrexic on presentation and anisocoria was present. It was treated with cooling, intravenous fluid, and phenobarbitone administration which was later changed to levetiracetam. An MRI was performed and revealed findings of a hypointense T1 and hyperintense T2 signal in the hippocampus and inferior temporal gyrus with mild gadolinium uptake, findings which were consistent with previous cases of hippocampal necrosis. The cat was witnessed to vomit and aspirate 24 hours after diagnosis leading to cardiac arrest and death. Postmortem examination revealed a subacute degenerative encephalopathy involving the hippocampus. [ABSTRACT FROM AUTHOR]