Posterior Reversible Encephalopathy Syndrome with Multiple Cerebellar Mass-Like Lesions Secondary to Amphetamine (P4.403)

Abstract

Objective: To report unusual brain MRI findings in a patient with posterior reversible encephalopathy syndrome (PRES) associated with amphetamine Background: When patient with PRES showed predominant mass-like lesions in cerebellum on neuroimaging, the diagnosis becomes challenging as tumors and other etiologies cannot be ruled out. Methods: Case analysis and literature review Results: A 45-year-old male with no known significant past medical history presented to emergency department due to an episode of severe headache. Patient denied any other associated symptoms. Initial systolic blood pressure was 250 mmHg and the rest of physical examination was unremarkable. Brain MRI showed multiple round shaped tumor-like hyperintense lesions in bilateral cerebellar hemispheres with minimal involvement of cerebral hemispheres on FLAIR and T2WI . There was no abnormal signal on any other sequences including post contrast study. CT angiogram of head and neck were unremarkable. Given the clinical presentation of high blood pressure, PRES was our first impression. However, the prominent lesions in the cerebellum with tumor-like morphology was uncommon in PRES and warranted further evaluation for alternative diagnosis. The patient was also found to be positive for amphetamine in a urine drug screen. After the cautious reduction of blood pressure, his clinical symptoms resolved. A follow-up MRI three days later showed significant improvement of the lesions. Therefore, PRES continued to be the primary diagnosis. Given the lack of supportive medical history associated to this condition, the likely cause for PRES is more likely related to amphetamine abuse Conclusions: PRES can present with a variety of MRI findings but predominant lesions in unusual locations such as cerebellum are uncommon. A follow up imaging and investigation for other etiologies are critical.

Disclosure: Dr. Tantikittichaikul has nothing to disclose. Dr. Ruthirago has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Claudio has nothing to disclose. Dr. Kim has nothing to disclose.