Posterior Reversible Encephalopathy Syndrome in a Case of Postoperative Spinal Extradural Haematoma: Case Report and Review of Literature

Abstract

A 14-year-old girl presented with progressive paraparesis and paresthesia of one-year duration. Magnetic resonance imaging revealed a T6 vertebral hemangioma with epidural compression on the spinal cord. Following angiography and embolization, she underwent dorsal laminectomy and excision of the soft tissue component compressing the cord. In the postoperative period she had rapid worsening of lower limb power and imaging demonstrated an epidural haematoma at the operative site. The patient was taken up for urgent re-exploration and evacuation of haematoma. Postoperatively the patient complained of visual failure, headache and had multiple episodes of seizures. An magnetic resonance imaging brain showed characteristic features of posterior reversible encephalopathy syndrome (PRES) and the patient improved gradually after control of hypertension. This is the first documented case of PRES following spinal cord compression in a patient without any known risk factors. We postulate the possible mechanism involved in its pathogenesis.

Posterior Reversible Encephalopathy Syndrome in an Infant Following Accidental Strangulation

“…1 It was first reported by Hinchey et al 2 in 1996 after an observational study on 15 patients. Since then, a few case reports 3,4 and some case series have been published in the literature describing this condition. [5][6][7][8][9][10] The most frequently implicated causes of PRES are hypertensive crisis, renal failure, fluid retention, and some immunosuppressive drugs.…”

“…It has also been reported in the clinical setting of hypocholesterolemia, hypomagnesaemia, hypercalcemia, aluminum overload, high-dose methylprednisolone therapy, uremic encephalopathy, pheochromocytoma, systemic lupus erythematosus, Henoch-Schönlein purpura, acute hepatic failure, thrombotic thrombocytopenic purpura, and human immunodeficiency virus infection by some investigators. 4 The exact pathophysiology has yet not been elucidated. It has been postulated that the clinical features might be due to sudden disruption of the autoregulatory mechanisms of the central nervous system vasculature, leading to vasoconstriction and vasodilatation, resulting in endothelial dysfunction and breakdown of the blood-brain barrier.…”

“…The predilection for involvement of posterior circulation territories is generally thought to result from the relatively sparse sympathetic innervations of the vertebrobasilar circulation. 3,4,9 Many nonhypertensive causes are being implicated as etiological associations of PRES. Nonhypertensive causes have been found to be commoner in childhood PRES, may be, because of the absence of arteriosclerosis and adequate plasticity of vessel walls in children making the vessel walls less vulnerable to sudden changes in blood pressure.…”

First reported case of posterior reversible encephalopathy syndrome occurring in a weightlifter

“…The result is an overwhelming of the autoregulation system of cerebral vasculature with areas of vasodilatation and vasoconstriction developing especially at arterial boundary zones 2 3. The predilection of the posterior circulation territories is thought to result from the relatively sparse sympathetic innervation of vertebrobasilar circulation.…”

Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: a case report

“…The common clinical features are headache, seizures, visual changes, altered mental status and focal neurological signs [3]. In a case series of 13 patients described by Varaprasad et al , headache and seizures were the most common manifestations [4].…”