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Posterior reversible encephalopathy syndrome with obstructive hydrocephalus. A case report
C Wirojtananugoon1, J Laothamatas
1Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Bangkok, Thailand - wchewarat@gmail.com.
The Neuroradiology Journal
|September 25, 2013
Summary
Posterior reversible encephalopathy syndrome (PRES) can cause severe brain swelling and herniation. Prompt blood pressure control and awareness of this PRES presentation may prevent complications like hydrocephalus and hemorrhage.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Posterior reversible encephalopathy syndrome (PRES) typically presents with headache, seizures, and visual disturbances.
- Unusual PRES presentations can mimic other neurological conditions, posing diagnostic challenges.
Purpose of the Study:
- To describe a rare case of PRES with predominant posterior fossa edema leading to obstructive hydrocephalus and herniation.
- To highlight the utility of advanced MRI techniques in differentiating PRES from brain tumors.
- To discuss the management and potential complications of this PRES variant.
Main Methods:
- Case report of a patient with PRES.
- Magnetic Resonance (MR) imaging, including MR spectroscopy and MR perfusion, was utilized for diagnosis.
- Treatment involved antihypertensive medication and cerebrospinal fluid diversion via ventriculostomy.
Main Results:
- The patient presented with posterior fossa edema, ascending transtentorial herniation, tonsillar herniation, and obstructive hydrocephalus.
- Advanced MR imaging successfully distinguished PRES from infiltrative tumor and supported a hydrostatic edema pathogenesis.
- Despite treatment, the patient developed thalamic and intraventricular hemorrhage with contralateral hemiparesis.
Conclusions:
- This case underscores the importance of recognizing PRES as a cause of obstructive hydrocephalus.
- Aggressive management of hypertension is crucial.
- Timely diagnosis and treatment may prevent severe complications such as hemorrhage and the need for ventriculostomy.
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