Cortical Laminar Necrosis and CT Negative Hemorrhage in Posterior Reversible Encephalopathy Syndrome

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic condition that typically demonstrates symmetric occipitoparietal vasogenic edema on CT and MR imaging. The vasogenic edema typically resolves over a period of days to weeks if the underlying hemodynamic abnormality is promptly corrected. Less commonly, PRES may be complicated by hemorrhage or cytotoxic edema that restricts diffusion and usually involves the cerebral cortex. Cortical laminar necrosis (CLN) is a sequela of cerebral energy depletion, resulting in selective necrosis of the most metabolically active cortical layers. Cortical hemorrhage is an atypical feature of CLN. We present a unique PRES case with imaging features of both CLN and CT negative hemorrhage. CLN with CT negative hemorrhage in the setting of PRES has not been previously reported to the best of our knowledge.