Patient 43 is a 53-year-old woman with a baseline blood pressure of 131/74 mm Hg who was receiving oral and skin patch narcotic pain control for a recently.

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Presentation transcript:

Patient 43 is a 53-year-old woman with a baseline blood pressure of 131/74 mm Hg who was receiving oral and skin patch narcotic pain control for a recently sustained pelvic fracture in a motor vehicle crash. Patient 43 is a 53-year-old woman with a baseline blood pressure of 131/74 mm Hg who was receiving oral and skin patch narcotic pain control for a recently sustained pelvic fracture in a motor vehicle crash. She developed nausea, vomiting, and altered mentation then progressed to generalized seizure with a blood pressure at toxicity of 149/105 mm Hg. A, Axial MR imaging (FLAIR sequence) obtained 1 day after acute toxicity demonstrates vasogenic edema in the occipital region (open arrows) consistent with PRES. Similar areas of vasogenic edema consistent with PRES was present in the frontal and parietal regions (not shown). B, MR angiogram obtained on the same day demonstrates areas of focal vasodilation in the branches of MCA bilaterally with focal vasoconstriction also noted on the left (arrows). C, Frontal view from the left common carotid catheter angiogram obtained the same day demonstrates an identical area of focal vasodilation and vasoconstriction in the branch of the left MCA (arrow). An identical finding was present at angiography in the right MCA consistent with the MRA observation on the right. Similar findings were present on both MRA and CA in the PCA bilaterally (not shown). W.S. Bartynski, and J.F. Boardman AJNR Am J Neuroradiol 2008;29:447-455 ©2008 by American Society of Neuroradiology