Hemorrhagic stroke with intraventricular extension in the setting of acute posterior reversible encephalopathy syndrome (PRES): Case report

Abstract

SummaryWe report the case of an eighteen year-old pregnant female with preeclampsia and florid signs and symptoms of posterior reversible encephalopathy syndrome (PRES) in whom intracerebral hemorrhage was evidenced following delivery. Management included blood pressure control, external ventricular drainage and lumboperitoneal shunt. To our knowledge this is the first report of intracranial hemorrhage occurring concurrently with peripartum acute PRES. This case was successfully treated with good outcome upon conclusion of management, thus making awareness of this potentially fatal complication and its suggested management for successful outcome necessary for neurosurgeons, neurologists and intensivists alike.KEY WORDS: Preeclampsia. PRES. Reversible encephalopathy. Intracranial hemorrhage. Intraventricular hemorrhage. External ventriculostomy drainage. Infarto hemorrágico con extensión intraventricular en el contexto de leucoencefalopatía aguda posterior reversible (LPR): descripción de un caso ResumenDescribimos el caso de una mujer embarazada de 18 años con preeclampsia y signos y síntomas floridos de leucoencefalopatía posterior reversible (LPR) en la que se evidenció la presencia de hemorragia cerebral tras el parto. El tratamiento de la enferma incluyó el control de la presión arterial, la utilización de drenaje ventricular externo y la colocación de una válvula lumboperitoneal. En nuestro conocimiento esta es la primera descripción en la literatura de la concurrencia de hemorragia intracraneal con la LPR. Este caso fue satisfactoriamente tratado con un buen resultado, haciendo que la sospecha y el conocimiento de esta posible fatal complicación y su correcto tratamiento sea importante para neurocirujanos, neurólogos e intensivistas.

A Unique Case of Intraventricular Hemorrhage Associated With Posterior Reversible Encephalopathy Syndrome in an Adolescent

“…The patient required ventriculostomy for increased intracranial pressure. 5 Although subarachnoid hemorrhage associated with posterior reversible encephalopathy syndrome has been reported in the literature, there is no prior report of intraventricular hemorrhage with associated subarachnoid hemorrhage. In a review of 23 patients with intracranial hemorrhage associated with posterior reversible encephalopathy syndrome by Hefzy et al, 7 patients were identified with subarachnoid hemorrhage and 2 patients with combined subarachnoid hemorrhage and parenchymal hemorrhage.…”

“…Only 2 cases of intraventricular hemorrhage complicating a posterior reversible encephalopathy syndrome presentation have been reported. 4,5 Aranas et al described a 56-year-old man 5 months status after liver transplantation on tacrolimus admitted for elevated liver function tests. Four days later, he developed encephalopathy and coma.…”

“…Only 2 cases of intraventricular hemorrhage complicating a posterior reversible encephalopathy syndrome presentation have been reported. 4,5 In both cases, the intraventricular hemorrhage was secondary to an extension of an intraparenchymal bleed and not a primary finding. We present a unique case of primary intraventricular hemorrhage with computed tomography (CT) and magnetic resonance imaging (MRI) findings in an 18-yearold female with posterior reversible encephalopathy syndrome and an antineutrophil cytoplasmic antibody-associated pauciimmune glomerulonephritis.…”

A Rare Case of Antepartum Posterior Reversible Encephalopathy Syndrome

“…As the name suggests, manifestations of PRES are usually transient and complete recovery is the rule. Most cases of PRES reported in the obstetric literature involve postpartum patients, with only a few cases of antepartum PRES [1][2][3][4] . We report a primigravid woman who presented with an abrupt onset of eclampsia and PRES.…”