Posterior reversible encephalopathy syndrome presenting in the anterior circulation with malignant intracranial hypertension requiring surgical decompression: a case report and literature review

Acta neurochirurgica
S Hernández-DuránC von der Brelie

Abstract

Posterior reversible encephalopathy syndrome (PRES) is thought to result from endothelial dysfunction and breakdown of the blood-brain barrier with subsequent vasogenic edema. Abrupt hypertension has been identified as one of its risk factors. We present a rare case of PRES in the anterior circulation with sudden onset of left hemiparesis and rapid neurological deterioration on the basis of hypertensive crisis. Due to refractory intracranial hypertension, the patient required emergent right decompressive craniectomy. Further investigations, including a biopsy, revealed an atypical form of PRES. This case illustrates the importance of aggressive medical and early surgical management to prevent permanent neurological deficits.

References

Mar 22, 2008·AJNR. American Journal of Neuroradiology·W S Bartynski
Jun 28, 2011·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Yuebing LiJohn Castaldo
Oct 2, 2012·PloS One·Stephane LegrielUNKNOWN Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS)
Aug 3, 2014·Clinical Neurology and Neurosurgery·Paul T AkinsMark W Hawk

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