Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicoradiological condition associated with headache, altered mental status, dizziness and white matter vasogenic oedema in parieto-occipital region. It is often associated with hypertension but can also occur in diverse clinical settings like immunosuppression, eclampsia, etc. It is due to failure of autoregulatory mechanism of posterior circulation in response to change in blood pressure. We hereby report a rare case of central variant of PRES secondary to severe hypertension diagnosed with 3T MRI. Objective of reporting this case was to describe the imaging findings of typical and rare atypical patterns of PRES. A 71-year-old male hypertensive patient was referred for brain imaging with history of short period of loss of consciousness, headache and dizziness. MRI brain showed central variant pattern of PRES with preferential involvement of brainstem, thalami and periventricular white matter with sparing of frontal, parietal and occipital lobes. The patient was treated with anti-hypertensive after which patient's symptoms subsided. The patient was followed up conservatively. Atypical variants of PRES should be borne in mind when pontine hyperintensity is encountered in hypertensive patient.
Keywords: Hypertension; Magnetic resonance imaging; Pontine hyperintensity.