Transcranial Doppler ultrasound in posterior reversible encephalopathy syndrome: A case report

I describe a case and brief discussion to illustrate the clinical utility of transcranial Doppler ultrasound in suspected posterior reversible encephalopathy syndrome. A 26-year-old female presented with headache, visual disturbance, dyspnoea and hypertension. Past medical history included heart transplantation and hypertension. Cytomegalovirus pneumonia with acute respiratory distress syndrome was diagnosed requiring mechanical ventilation and extracorporeal membrane oxygenation. A brain computed tomographic scan showed changes suggestive of posterior reversible encephalopathy syndrome. Transcranial Doppler showed increased velocities with low pulsatility index consistent with cerebral hyperaemia. After antihypertensive treatment flow velocities and computed tomography normalised with complete clinical recovery.