CT perfusion imaging in the management of posterior reversible encephalopathy

A 13-year-old girl with a renal transplant presented with hypertension and seizures. CT and MRI demonstrated typical bilateral parietal, occipital and posterior frontal cortical and subcortical edema, thought to represent posterior reversible encephalopathy syndrome. The cause was presumed to be hypertension. Antihypertensive therapy was started, lowering of the blood pressure in the range of 110-120 mmHg systolic. However, stable xenon (Xe) CT perfusion imaging revealed ischemia within the left parietal occipital region. The antihypertensive was adjusted which increased both the systolic and diastolic blood pressure by 31 mm Hg. The patient was re-imaged with Xe CT and was found to have resolution of the ischemic changes within the left parietal occipital region. In this report, we present a case in which stable Xe CT was used to monitor the degree of cerebral perfusion and guide titration of antihypertensive therapy. Such brain perfusion monitoring may have helped to prevent infarction of our patient.