CRCM  Vol.4 No.5 , May 2015
Decompressive Craniectomy for Posterior Reversible Encephalopathy Syndrome (PRES): Case Report
ABSTRACT
Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon clinical-neuroradiological syndrome with an unclear pathophysiology. Correlation between PRES and the use of immunosuppressant drugs have previously been described, as well as correlation between elevated blood pressure and PRES. Characteristic brain MRI manifestations include hyperintense lesions on T2 and FLAIR (fluid-attenuated inversion recovery) images. PRES is usually reversible within a short period of time after discontinuation of the presumably offending drug. Some cases of PRES might complicate with intracranial hemorrhage, refractory status epilepticus or expansive vasogenic brain edema (also regarded as “tumefactive” PRES). Methods: We present a case of a young man diagnosed with Hodgkin’s lymphoma, following a laparotomy due to cecal volvulus. The patient received glucocorticoids and elevated blood pressure values were recorded. Brain imaging studies were performed due to generalized epileptic seizures, demonstrating neuroradiological findings consistent with PRES. Neurological and neuroradiological deterioration was noted, necessitating urgent neurosurgical intervention. A complete neurological and functional rehabilitation was achieved. Conclusion: The uncommon cases of complicated PRES should be taken under consideration whenever clinical deterioration is noted following the diagnosis of PRES. Early neuroradiological evaluation should be sought, together with aggressive medical and surgical treatment in cases of life threatening mass effect.

Cite this paper
Azriel, A. , Melamed, I. , Shelef, I. , Sufaro, Y. , Gidon, M. , Merkin, V. , Shtreizent, A. and Cohen, A. (2015) Decompressive Craniectomy for Posterior Reversible Encephalopathy Syndrome (PRES): Case Report. Case Reports in Clinical Medicine, 4, 169-174. doi: 10.4236/crcm.2015.45034.
References
[1]   Hinchey, J., Chaves, C., Appignani, B., Breen, J., Pao, L., Wang, A., Pessin, M.S., Lamy, C., Mas, J.L. and Caplan, L.R. (1996) A Reversible Posterior Leucoencephalopathy Syndrome. The New England Journal of Medicine, 334, 494-500.
http://dx.doi.org/10.1056/NEJM199602223340803

[2]   Casey, S.O., Sampaio, R.C., Michel, E. and Truwit, C.L. (2000) Posterior Reversible Encephalopathy Syndrome: Utility of Fluid-attenuated Inversion Recovery MR Imaging in the Detection of Cortical and Subcortical Lesions. American Journal of Neuroradiology, 21, 1199-1206.

[3]   Lamy, C., Oppenheim, C., Meder, J.F. and Mas, J.L. (2004) Neuroimaging in Posterior Reversible Encephalopathy Syndrome. Journal of Neuroimaging , 14, 89-96.

[4]   Marra, A., Vargas, M., Striano, P., Del Guercio, L., Buonanno, P. and Servillo, G. (2014) Posterior Reversible Encephalopathy Syndrome: The Endothelial Hypotheses. Medical Hypotheses, 82, 619-622.
http://dx.doi.org/10.1016/j.mehy.2014.02.022

[5]   Heo, K., Park, S.A., Lee, J.Y., Lee, B.I. and Lee, S.K. (2003) Post-Transfusion Posterior Leukoencephalopathy with Cytotoxic and Vasogenic Edema Precipitated by Vasospasm. Cerebrovascular Diseases, 15, 230-233.
http://dx.doi.org/10.1159/000068825

[6]   Pedraza, R., Marik, P.E. and Varon, J. (2009) Posterior Reversible Encephalopathy Syndrome: A Review. Critical Care and Shock, 12, 135-143.

[7]   Irvin, W., MacDonald, G., Smith, J.K. and Kim, W.Y. (2007) Dexamethasone-Induced Posterior Reversible Encephalopathy Syndrome. Journal of Clinical Oncology, 25, 2484-2486.
http://dx.doi.org/10.1200/JCO.2007.10.9991

[8]   Hansberry, D., Agarwal, N., Tomei, K. and Goldstein, I. (2013) Posterior Reversible Encephalopathy Syndrome in a Patient with a Chiari I Malformation. Surgical Neurology International, 4, 130.

[9]   Wada, K., Kano, M., Machida, Y., Hattori, N. and Miwa, H. (2013) Posterior Reversible Encephalopathy Syndrome Induced after Blood Transfusion for Severe Anemia. Case Reports in Clinical Medicine, 5, 332-334.

[10]   Fugate, J.E., Claassen, D.O., Cloft, H.J., Kallmes, D.F., Kozak, O.S. and Rabinstein, A.A. (2010) Posterior Reversible Encephalopathy Syndrome: Associated Clinical and Radiologic Findings. Mayo Clinic Proceedings, 85, 427-432.
http://dx.doi.org/10.4065/mcp.2009.0590

[11]   Lee, V.H., Wijdicks, E.F.M., Manno, E.M. and Rabinstein, A.A. (2008) Clinical Spectrum of Reversible Posterior Leukoencephalopathy Syndrome. Archives of Neurology, 65, 205-210.

[12]   Nagaoka, Y., Ishikura, K., Hamada, R., Miyagawa, T., Kono, T., Sakai, T., Hamasaki, Y., Hataya, H. and Honda, M. (2013) Severe Posterior Reversible Encephalopathy Syndrome Resolved with Craniectomy. Pediatrics International, 55, 644-646.
http://dx.doi.org/10.1111/ped.12084

[13]   Rykken, J.B. and McKinney, A.M. (2014) Posterior Reversible Encephalopathy Syndrome. Seminars in Ultrasound, CT, and MRI, 35, 118-135.

[14]   Bartynski, W.S. (2008) Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features. American Journal of Neuroradiology, 29, 1036-1042.
http://dx.doi.org/10.3174/ajnr.A0928

[15]   Liman, T.G., Bohner, G., Heuschmann, P.U., Endres, M. and Siebert, E. (2012) The Clinical and Radiological Spectrum of Posterior Reversible Encephalopathy Syndrome: The Retrospective Berlin PRES Study. Journal of Neurology, 259, 155-164.
http://dx.doi.org/10.1007/s00415-011-6152-4

[16]   Hefzy, H.M., Bartynski, W.S., Boardman, J.F. and Lacomis, D. (2009) Hemorrhage in Posterior Reversible Encephalopathy Syndrome: Imaging and Clinical Features. American Journal of Neuroradiology, 30, 1371-1379.

[17]   Akins, P.T., Axelrod, Y., Silverthorn, J.W., Guppy, K., Banerjee, A. and Hawk, M.W. (2014) Management and Outcomes of Malignant Posterior Reversible Encephalopathy Syndrome. Clinical Neurology and Neurosurgery, 125, 52-57.
http://dx.doi.org/10.1016/j.clineuro.2014.06.034

[18]   Cordelli, D.M., Masetti, R., Ricci, E., Toni, F., Zama, D., Maffei, M., Gentili, A., Parmeggiani, A., Pession, A. and Franzoni, E. (2014) Life-Threatening Complications of Posterior Reversible Encephalopathy Syndrome in Children. European Journal of Pediatric Neurology, 18, 632-640.
http://dx.doi.org/10.1016/j.ejpn.2014.04.014

 
 
Top