Fishing in muddy waters- co-existing dual intracranial pathology in PRES: A case series and review of literature

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state often characterized by altered mental state and is seen in various clinical settings. Although it is often reversible, it may result in long term sequelae. The typical and atypical neuroimaging findings seen in PRES have been previously well-described in the literature. However, the presence of other co-existing intracranial lesions along with PRES can occasionally confound the imaging findings and poses a diagnostic challenge. Herein, the authors report four cases of PRES with etiologically different co-existing intracranial lesions confounding the clinical and imaging manifestations. When presented with atypical imaging findings in PRES, the possibility of a co-existing intracranial pathology with superimposed imaging findings should be considered.