Fig 3.

Leptomeningeal enhancement pattern in “mild” PRES. A 19-year-old woman with a history of systemic lupus erythematosus and pancytopenia presented with a seizure (blood pressure unavailable). A 1.5T MR imaging demonstrates mild parieto-occipital edema on FLAIR (A), with moderate leptomeningeal enhancement (thin arrows) on both gadolinium-enhanced FLAIR (B) and T1WI (C). D–F, A follow-up MR imaging 2 months later shows that both the mild cortical and subcortical edema on FLAIR (D) has resolved as well as the leptomeningeal enhancement on gadolinium-enhanced FLAIR (E) and T1WI (F). While gadolinium-enhanced FLAIR was not used to score the degree of edema or enhancement, the use of postcontrast FLAIR in this example demonstrates how enhancement can occur in areas lacking edema on noncontrast FLAIR, perhaps due to transient blood-brain barrier injury.