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Case Reports in Neurological Medicine
Volume 2013, Article ID 536978, 4 pages
Case Report

Reversible Confluent Deep White Matter Abnormalities: A New Variant of Posterior Reversible Encephalopathy Syndrome

1Neuromuscular Center, Cleveland Clinic, Mail Code S90, 9500 Euclid Avenue, Cleveland, OH 44195, USA
2Center for Advanced Health Care, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Suite 405, Allentown, PA 18103, USA
3Medical Imaging of Lehigh Valley, Lehigh Valley Health Network, Cedar Crest & I-78, P.O. Box 689, Allentown, PA 18105, USA

Received 23 August 2013; Accepted 22 October 2013

Academic Editors: P. Berlit, M. Filosto, J. L. González-Gutiérrez, R. Koide, and J.-H. Park

Copyright © 2013 Yuebing Li et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We describe a confluent deep white matter abnormalities variant of PRES, further strengthening the notion that PRES is a disorder of radiological heterogeneity. We present 2 cases of PRES with findings of diffuse but reversible vasogenic edema located in the deep periventricular white matter regions of bilateral hemispheres without a clearly posterior distribution. We feel that this represents a rare variant of PRES on imaging, thus adding to the existing radiological spectrum for this entity. Both of our patients presented with malignant hypertension (mean arterial blood pressure of 200 mmHg) and developed neurological symptoms that included encephalopathy, seizure, headache, and vision changes. Additionally, both patients presented with significant subcortical white matter edema that improved dramatically on follow-up imaging. The clinical and radiological improvement in both patients occurred following successful blood pressure management. It is possible that the deep white matter changes of PRES are seen exclusively in the setting of severe accelerated hypertension. Our case reports reveal that, in patients with hypertensive encephalopathy, a deep white matter pattern of diffuse signal changes may not necessarily indicate chronic ischemic changes and follow-up imaging studies are essential to rule out a diagnosis of PRES.