Posterior reversible encephalopathy syndrome with lumbar drainage and surgery: coincidence or correlation? A case report

Abstract

Background Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder usually associated with specific medical conditions that cause a disturbance of the CNS homeostasis. It has seldom been reported to be a consequence of an iatrogenic intervention causing intracranial hypotension. Case presentation We report the case of an individual 69-year-old male presenting with headache and blurred vision following cerebrospinal fluid (CSF) leak from resection of a sellar mass. The patient developed the condition following removal of the lumbar drain post-operatively. Magnetic Resonance Imaging showed bilateral occipital, parieto-occipital, and cerebellar T2 FLAIR hyper-intensities, suggesting a radiological diagnosis of posterior reversible encephalopathy syndrome (PRES). The patient’s symptoms started to improve shortly afterwards and had completely resolved at 3 months follow-up. Conclusions The absence of severe hypertension and presence of an intraoperative CSF leak requiring placement of the lumbar drain suggests that decreased CSF volume and associated reactive hyperemia could have a role in the pathophysiology of the disease.

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

“…In most cases Figure 2, no intra-operative complications were reported in the selected studies. We found that there was a higher percentage for certain types of surgery, such as in the case of neurosurgical pathology [16,24,28,29,32], both cranial and spinal [15,18,19,36,42,49]. In some cases, the risk factor for PRES was sustained by hypertension caused by incomplete postoperative pain control [67].…”

Acute posterior reversible encephalopathy syndrome (PRES) in setting of interferon-beta use: case presentation with reduction of edema in 72 h after cessation of interferon-beta therapy with sub-clinical inflammation

“…Posterior reversible encephalopathy syndrome is a recently described (1996) and likely underreported phenomenon with complex etiology secondary to alterations in hemodynamics, osmolality, inflammation and endothelial dysregulation [ 1 ]. It may be acutely exacerbated by transient rise in blood pressure and is often seen in the setting of autoimmune disease, immunosuppressive drugs, and infection [ 3 , 13 ]. Seizures on initial presentation is common, and would raise index of suspicion for PRES in middle-aged females with acute-onset encephalopathy and uncontrolled systolic blood pressure [ 3 ].…”