Clinical Images: Scurvy in the modern era

✍ Scribed by Brian DelVecchio; Sorina Dancea

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 65 KB
• Volume: 63
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.27743

✦ Synopsis

Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping can help to differentiate an ischemic lesion, which appears hyperintense on DWI and hypointense on ADC maps, from a lesion due to PRES, which does not appear hypointense on ADC maps (5). The distinction between PRES and central nervous system vasculitis can easily be made, since vasculitis lacks the typical MRI findings of PRES, and the diagnosis relies on corroborative data from cerebrospinal fluid analysis, angiography, and perfusion studies, with brain biopsy being the gold standard.

When we initially presented our case, we decided against showing the subsequent MRI, since PRES MRI at presentation is characteristic and particularly useful in guiding diagnosis and treatment. We concur that reversibility is essential to the diagnosis of PRES and that was convincingly demonstrated in our patient during the followup MRI series, performed 1 year after the initial diagnosis. We observed a dramatic resolution of the characteristic lesions, aside from a small area of watershed infarction (Figures 1A andB).