Reversible posterior leukoencephalopathy syndrome combined with left middle cerebral artery occlusion and unilateral imaging involvement: A case report.

OBJECTIVE: Posterior Leukoencephalopathy Syndrome is a condition shown by specific brain changes. It mostly involves swelling in brain tissue. This paper talks about an unusual case of posterior reversible encephalopathy syndrome (PRES). A 38-year-old man with high blood pressure (highest recorded:200/100 mmHg) was hospitalized due to ``ongoing headaches for half a year, which got worse with nosebleeds over 3 days''. Tests showed swelling on the right side of the brain (observed as bright signals on T2/FLAIR and high ADC values) and blockage in the left middle cerebral artery.

OUTCOME: Experts from various fields confirmed the diagnosis of unusual PRES. Main point that stands out here: left MCA block led to increased blood flow on the opposite side to make up for it, causing 1-sided imaging effect. When blood pressure was lowered step by step (goal: systolic pressure of 130 mmHg or less), MRI taken a week later showed some reduction in swelling.

CONCLUSION: This case shows that blocked blood vessels along with sudden changes in blood pressure might cause unusual PRES patterns, and finding it early with careful blood flow control is key to a better outcome.