Imaging recommendation · Neuro · Head & Neck

Acute neuro decline with hypertensive crisis or post-chemo, suspected PRES

Q: What's the alternative imaging for acute neuro decline with hypertensive crisis or post-chemo, suspected pres when hemorrhagic transformation suspected?

MRI — Add SWI / GRE sequence (no contrast).

Recommended: MRI Brain (with FLAIR + DWI) is the preferred imaging study for acute neuro decline with hypertensive crisis or post-chemo, suspected pres. Symmetric posterior parieto-occipital vasogenic edema.

Recommended study

MRI Brain (with FLAIR + DWI)

MRI No contrast Preferred Neuro · Head & Neck Acute inpatient Reviewed 2026-05

Symmetric posterior parieto-occipital vasogenic edema. Reversible with BP / trigger control.

If the default doesn't apply

Hemorrhagic transformation suspected

MRI Add SWI / GRE sequence No contrast

Watch-outs

Atypical distribution

PRES can involve cerebellum, brainstem, deep gray matter — don't exclude based on classic posterior distribution alone.

Eclampsia / post-partum

PRES is the imaging correlate of eclampsia — magnesium, BP control, delivery.

Pearls

Triggers: hypertensive crisis, eclampsia, post-chemo (especially platinum, cyclosporine, tacrolimus), autoimmune, sepsis.
Distinguish from acute stroke: PRES typically bilateral, T2 / FLAIR hyperintense without DWI restriction.
RCVS often coexists; image vessels with MRA / CTA.