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Intracranial hypotension and PRES: case report
Silvia Pugliese1, V Finocchi, M L Borgia
1Department of Neuroradiology, University of Rome La Sapienza, Rome, Italy. silviapugliese@gmail.com
The Journal of Headache and Pain
|June 3, 2010
Summary
A woman developed intracranial hypotension (IH) and posterior reversible encephalopathy syndrome (PRES) after an epidural. Treatment with a blood patch resolved symptoms and radiological findings, suggesting IH may trigger PRES.
Area of Science:
- Neurology
- Anesthesiology
- Radiology
Background:
- Epidural analgesia, commonly used for cesarean sections, carries a risk of inadvertent dural puncture.
- Intracranial hypotension (IH) can occur following dural puncture, leading to symptoms like severe headache.
- Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by headache, seizures, and visual disturbances.
Observation:
- A patient presented with worsening headache and seizures 7 days post-epidural analgesia for cesarean delivery.
- Magnetic Resonance Imaging (MRI) revealed signs consistent with intracranial hypotension and posterior reversible encephalopathy syndrome.
- The patient underwent a blood patch procedure for treatment.
Findings:
- The blood patch led to rapid improvement of the patient's clinical symptoms.
- Follow-up MRI after 15 days demonstrated complete resolution of the radiological abnormalities.
- The case highlights a potential link between IH secondary to dural puncture and the development of PRES.
Implications:
- This case suggests that intracranial hypotension may play a significant role in the pathogenesis of PRES.
- Venous stasis and hydrostatic edema, resulting from IH, are proposed as key contributing factors to PRES development.
- Understanding this relationship can inform clinical management and preventative strategies for patients experiencing complications after epidural procedures.
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