Decompressive Craniectomy for Posterior Reversible Encephalopathy Syndrome (PRES): Case Report - Case Reports in Clinical Medicine

CRCM > Vol.4 No.5, May 2015

Decompressive Craniectomy for Posterior Reversible Encephalopathy Syndrome (PRES): Case Report (Short Report)

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DOI: 10.4236/crcm.2015.45034 2,855 Downloads 3,814 Views Citations

Author(s)

Amit Azriel^1*, Israel Melamed¹, Ilan Shelef², Yuval Sufaro³, Micky Gidon¹, Vladimir Merkin¹, Alexandr Shtreizent¹, Avi Cohen¹

Affiliation(s)

¹Department of Neurosurgery, Soroka Medical Center, Be’er-Sheva, Israel.
²Diagnostic Imaging Institute, Soroka Medical Center, Be’er-Sheva, Israel.
³Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.

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.

KEYWORDS

PRES, Posterior Reversible Encephalopathy Syndrome, Brain Edema, Craniectomy

Share and Cite:

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.

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