Neuroimaging: PRES: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: PRES

Sample item

A woman with severe hypertension and eclampsia has headache, visual disturbance and seizures. MRI shows bilateral symmetrical T2/FLAIR hyperintensities in the parieto-occipital white matter. What is the diagnosis?

ACentral pontine myelinolysisBMultiple sclerosisCPosterior reversible encephalopathy syndromeDProgressive multifocal leukoencephalopathy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Posterior reversible encephalopathy syndrome

PRES results from vasogenic oedema, mainly in the posterior circulation territories, due to failure of autoregulation in hypertension, eclampsia or immunosuppression. It is usually reversible after control of blood pressure. PML is asymmetric and subcortical in immunosuppressed patients.

Option by option

A. Central pontine myelinolysis
Central pontine myelinolysis follows rapid correction of hyponatraemia.
B. Multiple sclerosis
MS shows ovoid periventricular lesions.
C. Posterior reversible encephalopathy syndrome (correct)
Correct. Bilateral posterior vasogenic oedema in hypertension suggests PRES.
D. Progressive multifocal leukoencephalopathy
PML shows asymmetric subcortical white matter lesions with no mass effect in AIDS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Posterior reversible encephalopathy syndrome. PRES results from vasogenic oedema, mainly in the posterior circulation territories, due to failure of autoregulation in hypertension, eclampsia or immunosuppression.

Why is "Central pontine myelinolysis" not the answer?

Central pontine myelinolysis follows rapid correction of hyponatraemia.

Why is "Multiple sclerosis" not the answer?

MS shows ovoid periventricular lesions.

Why is "Progressive multifocal leukoencephalopathy" not the answer?

PML shows asymmetric subcortical white matter lesions with no mass effect in AIDS.

What concept does this question test?

It tests Neuroimaging: PRES in Radiology. It is usually reversible after control of blood pressure. PML is asymmetric and subcortical in immunosuppressed patients.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: PRES?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.