Diagnosis: Unspecified convulsions Liver transplant statusClinical question: evaluate for PRESS, vasculitis, intracranial mass, PTLDSigns and Symptoms: seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is T2 and FLAIR signal hyperintensity involving the subcortical white matter of the occipital, parietal and frontal lobes in a watershed type distribution. There is no associated hemorrhage diffusion restriction or contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are partly opacified. The visualized portions of the orbits are intact. The eyes are mildly elongated in the AP dimension.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse sinus is smaller than the right transverse sinus.
1.Findings are compatible with posterior reversible encephalopathy syndrome (PRES).2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.MR venogram of the brain is within normal limits