Devil is in the detail, subtle signs of posterior reversible encephalopathy syndrome

A 33-year-old woman presented to the hospital with convulsive seizure and hypertensive crisis. As differential diagnosis cortical venous thrombosis, ischaemic or haemorrhagic stroke, space occupying lesion, Posterior Reversible Encephalopathy Syndrome (PRES) and epileptic syndrome were considered. Antiepileptic and antihypertensives drugs were used as initial clinical management. Magnetic Resonance Imaging (MRI) findings in this case include hyperintensity of frontoparietal parasagittal margins and right central sulcus, signs of subarachnoid hemorrhage (A, asterisk, Figure) associated with bilateral and symmetrical increased signal in occipital and parietal region with posterior distribution (B, arrows, Figure) and adequate permeability of the intracranial vascular structures. The neuroimaging along with the clinical context guides the diagnosis.