Generalised reversible encephalopathy syndrome: a variant of posterior reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome characterised by headache, visual disturbance, seizures and altered consciousness. Radiological findings show hyperintense T2-lesions on MRI, predominantly located in the subcortical white matter of the posterior occipital and parietal lobes. We report the case of a 74-year-old woman with adenocarcinoma of the gastric cardia who developed severe neurological signs and symptoms. MRI of the brain showed atypical generalised hyperintense lesions on T2 and fluid-attenuated inversion recovery sequences. Under symptomatic treatment, the radiological changes as well as neurological signs and symptoms improved. Several potential risk factors for PRES, such as hypertensive crisis, blood transfusions, infection and cancer, were identified in our patient, whereby perhaps the coexistence of these risk factors led to the unusual radiological and clinical manifestation of a generalised PRES variant.