Question 2591
{"accessible":true,"alternatives":[{"id":12719,"text":"embolic infarcts"},{"id":12718,"text":"heroin-induced leukoencephalopathy"},{"id":12717,"text":"hypoglycemic encephalopathy"},{"id":12716,"text":"osmotic demyelination syndrome"},{"id":12715,"text":"posterior reversible encephalopathy syndrome"}],"archived":false,"correctAlternativeId":12715,"explanation":"\u003cp\u003eThe image shows subcortical white matter FLAIR hyperintensity, compatible with vasogenic edema, involving the bilateral parietal lobes and under the superior frontal sulci. This distribution, in addition to occipital lobe and cerebellar involvement, is typical of posterior reversible encephalopathy syndrome (PRES). This patient had an episode of severe hypertension, a risk factor that corroborates this diagnosis.\u003c/p\u003e\u003cp\u003eEmbolic infarcts is a possibility on this image but more cortical involvement and diffusion restriction (not shown) would be needed to make the diagnosis of ischemic stroke.\u003c/p\u003e\u003cp\u003eHeroin leukoencephalopathy affects white matter but especially the corticospinal tracts, which are spared in this case image that covers some of the perirolandic region.\u003c/p\u003e\u003cp\u003eHypoglycemic encephalopathy characteristically involves the cerebral cortex and deep white matter such as the posterior limb of the internal capsule or splenium of the corpus callosum.\u003c/p\u003e\u003cp\u003eOsmotic demyelination most often involves the pons or other deep brain structures.\u003c/p\u003e","id":2591,"imageUrl":"https://prod-images-static.radiopaedia.org/images/55760398/24_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":92419},"imageAttributionCaseInfo":{"title":"PRES with cerebellar involvement and hemorrhage","contributor_name":"Frank Gaillard","contributor_param":"frank","case_rid":92419,"case_param":"pres-with-cerebellar-involvement-and-haemorrhage"},"firstQuestionPath":"/questions/2591","nextQuestionPath":"/articles/ischaemic-stroke/questions/2415","relatedArticles":[{"id":4441,"title":"Heroin-induced leukoencephalopathy","link":"/articles/heroin-induced-leukoencephalopathy?lang=us"},{"id":1915,"title":"Posterior reversible encephalopathy syndrome","link":"/articles/posterior-reversible-encephalopathy-syndrome-1?lang=us"},{"id":1077,"title":"Osmotic demyelination syndrome","link":"/articles/osmotic-demyelination-syndrome?lang=us"},{"id":37277,"title":"Hypoglycemic encephalopathy","link":"/articles/hypoglycaemic-encephalopathy?lang=us"}],"alsoUsedIn":[{"id":1397,"kind":"RestrictedPage","title":"Page 1397 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/2238"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 35-year-old has a seizure and is evaluated with MRI. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2591"}],"attemptsPercentages":[{"alternativeId":"12715","percentage":75},{"alternativeId":"12718","percentage":5},{"alternativeId":"12719","percentage":12},{"alternativeId":"12716","percentage":2},{"alternativeId":"12717","percentage":5}],"promptToLogin":false,"questionManager":false,"articleId":"ischemic-stroke"}