Thread by @SinaiBmoreIMRes

1/9
#Morningreport this week @SinaiBmoreIMRes
featured an interesting case by N. walia
A young Pt presenting with pancreatitis - develops complaints of "bilateral vision loss with progressively worsening headaches "
DDx ???
#MedTwitter #Medstudenttwitter

2/9
BP noted to be: BP: 207/117
Exam:
Eyes: EOMI.
Cannot count fingers.
Appreciates some movement on the right which appear as shadows.
Unable to detect static objects
Neuro: Exam normal

3/9
DDx: Vision loss/Headache ??
Giant Cell Arteritis (GCA)
Migraine
Retinal migraine
Hypertensive retinopathy
optic neuritis
Cerebral venous sinus thrombosis
Intracranial hemorrhage
Posterior circulation stroke
Primary CNS vasculitis
etc

4/9
CT HEAD: CT Head WO Contrast: ill-defined hypoattenuation involving predominantly the subcortical white-matter in both parietal and occipital lobes, concerning for PRES
researchgate.net/figure/Posteri…

5/9
The Dx of PRES was made with signs suggestive on MRI:

6/9:
Pathogenesis:

7/9:
Causes & Presentation

8/9
A few Ddx of PRES:
ICH
Subdural/Subarachnoid hemorrhage
Cerebral sinus venous thrombosis
Posterior circulation ischemic or hemorrhagic stroke
thrombosis of the basilar artery
Vasculitis of the CNS
HSV encephalitis
Autoimmune encephalitis
Uremic encephalopathy
Hypoglycemia

9/9
Management: