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DISCUSSION: PRES with both vasogenic and cytotoxic edema is rare. Our patient had a recent MRI brain and PET/CT for tumor staging, which was negative for brain metastasis. There was a lack of evidence supporting an alternative cause for development of cytotoxic edema making PRES the most likely cause. Several studies have reported cytotoxic edema in PRES. In them, endothelial dysfunction seems to cause both vasogenic and cytotoxic edema occurs in PRES, with areas surrounding marked vasogenic edema usually progressing to cytotoxic edema.

CONCLUSIONS: There is increasing evidence for development of PRES with several chemotherapy agents like carboplatin/paclitaxel. It may be characterized by vasogenic as well as cytotoxic edema. Cytotoxic edema is probably related to local decreased perfusion and arteriolopathy. Further research is warranted to understand the pathophysiologic …