Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, and sepsis. This is a case report of a 39-year-old woman with untreated HIV infection and end-stage renal disease (ESRD) who developed PRES with a normal blood pressure and no other known causes of PRES. Untreated HIV is associated with known endothelial dysfunction and we believe that this, in combination with her untreated end-stage renal disease, contributed to her unique presentation of PRES. Although uncommon in HIV-infected patients and challenging to diagnose, prompt recognition of PRES is critical to provide appropriate care and ensure reversibility of the vasogenic edema seen in PRES.

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Takotsubo cardiomyopathy (TC) is a syndrome that predominantly affects postmenopausal women and is characterized by transient regional systolic dysfunction of the left ventricle which occurs in the absence of angiographic evidence of significant obstructive coronary artery disease. It is often but not always triggered by emotional or physical stressful stimuli. In most cases, the regional ventricular dysfunction extends beyond a single epicardial coronary artery territory. It typically involves the apex, with rare atypical presentations involving the base and right ventricle. Although the pathophysiological underpinnings of TC have not been completely elucidated, possible mechanisms include catecholamine overactivity, diffuse multivessel coronary spasm, microvascular dysfunction and estrogen deficiency. The prevalence of diabetes mellitus has been noted to be low in multiple studies of patients with TC. In this review, the authors discuss the association between diabetes mellitus and TC, with a special emphasis on the possible protective effect of diabetes mellitus in development of TC. Key words:Diabetes mellitus, stress cardiomyopathy, takotsubo cardiomyopathy ABSTRACTArticle history:

While the previously described prediction score effectively identifies patients who can successfully undergo stress-first MPI, it is cumbersome. Triaging based solely on CAD status and with the addition of other key variables is practical and provides improved predictive accuracy for successful stress-first MPI. Utilizing this simplified pre-test scoring model may allow for wider adoption of stress-first imaging protocols which have clear advantages over traditional rest-stress protocols.