Etiology of posterior reversible encephalopathy syndrome [PRES]

To study the causes and risk factors for the development of Posterior Reversible Encephalopathy Syndrome [PRES]. Prospective hospital based study over a period of five years from July 1999 to June2004.Patients and methods: Patients with clinical and neuroimaging features consistent with PRES were included in the study. All patients had detail clinical evaluation on presentation, and recovery from PRES. All had CT and/or MRI brain scan and other hematological and serological investigations to determine the most likely cause of the syndrome. Most patients also underwent follow up neuroimaging to demonstrate resolution of brain lesions. Thirteen patients fulfilled the clinical and radiological features consistent with PRES. Seizures and altered conscious level were most common clinical manifestations. Main radiological feature on CT and/or MRI brain was extensive subcortical edema mainly confined to the posterior parieto-occipital lobes. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia were main causes of PRES in our study. We also found that this syndrome was more common in females than males. Clinically all patients recovered with control of blood pressure and discontinuation or reduction in dose of the offending drug within 2-7 days. There was almost complete resolution of radiological abnormalities within 2-4 weeks in patients who underwent follow up imaging. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia are most common causes of posterior reversible encephalopathy syndrome with a greater predilection for females than males. Multiple factors may be contributory in some patients who develop PRES

Twin reversed arterial perfusion [TRAP] sequence

Herein, we describe three unrelated cases with acardius in which the heart and other parts of the body are formed imperfectly in one of the twins. Clinically, the three cases showed no skull, face or neck, Both upper limbs were absent in case I and II while the right upper limb was absent in case II, Oligodactyly or segmentation of the lower limbs were observed in three cases. Ultrasonography showed an irregularly shaped microcephalic head which looked like a pigeon-head surrounded by an unusual diffuse impression of a banana slice. The facial features were absent. The etiology and pathogenesis of acardius together with the ultrasonographic findings are discussed