Usefulness of MRI Arterial Spin Labeling in the Diagnosis of Posterior Reversible Encephalopathy Syndrome in a Patient With Type 2 Diabetes: A Case Report

Abstract

A 56-year-old man was transported to our hospital by ambulance due to headache, vomiting, and impaired consciousness. He had right homonymous inferior quadrantanopsia and his blood pressure was 192/100 mmHg. A laboratory analysis revealed the following: serum glucose, 233 mg/dL; HbA1c, 10.8 %; urinary protein excretion, 12.0 g/gCr; serum albumin, 2.1 g/dL; and eGFR, 41 mL/min/1.73 m². Fluid attenuated inversion recovery and T2-weighted head MRI showed chronic ischemic lesions in the white matter. Arterial spin labeling (ASL) demonstrated hyperperfusion in the left parietal and occipital lobes. The patient was diagnosed with posterior reversible encephalopathy syndrome (PRES). The patient's hyperperfusion and visual field loss almost normalized, along with his blood pressure and glycemic control. The current case report suggests the usefulness of ASL in the diagnosis of PRES in the clinical setting.