Central Variant Posterior Reversible Encephalopathy Syndrome: A Masquerader with Brainstem and Basal Ganglia Involvement Lacking Cortical or Subcortical Edema

Aim: To present a rare case of central variant of posterior reversible encephalopathy syndrome. Clinical presentation: A 50-year-old male hypertensive patient with electrolyte imbalance presented with acute onset of headache, decreased vision, slurring of speech and ataxia with hypersomnolence. MRI brain showed diffuse T2/FLAIR hyperintensity of bilateral basal ganglia, brainstem and bilateral cerebellar peduncles without cortical or subcortical involvement. Result: The isolated involvement of brain stem and basal ganglia without cerebral hemispheric involvement is rare and can be called ‘central variant’ Posterior Reversible Encephalopathy Syndrome, which can result in diagnostic confusion with osmotic demyelination, especially when the patient has associated chronic kidney disease and electrolyte imbalance. Conclusion: When the MRI shows isolated involvement of brain stem and basal ganglia the diagnosis of central variant PRES should be considered in patients with hypertension even in the presence of electrolyte imbalance.