Pressurized Contrast-Related Posterior Reversible Encephalopathy Syndrome After Cerebral Digital Subtraction...

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by vasogenic edema due to disrupted cerebrovascular autoregulation.
• Commonly associated with hypertension, chemotherapy, and transplantation, PRES also poses a risk to neurosurgical patients.

Purpose of the Study:

• To highlight the risk of PRES in neurosurgical patients undergoing digital subtraction angiography.
• To present a case study of PRES development in a patient with a history of traumatic brain injury.

Main Methods:

• Case report of a patient who developed PRES following surveillance digital subtraction angiography for a pseudoaneurysm.
• Diagnosis based on clinical presentation, neuroimaging (MRI), electroencephalography, and exclusion of other conditions.
• Review of risk factors and pathophysiology of PRES.

Main Results:

• The patient presented with neurological deficits (gaze deviation, hemiplegia, seizures) and MRI findings consistent with PRES.
• Diagnosis was confirmed by characteristic radiographic features, normal labs, and electroencephalography.
• The patient experienced spontaneous clinical improvement.

Conclusions:

• Neurosurgical patients, particularly those with a history of traumatic brain injury or undergoing procedures affecting cerebral blood flow, are at risk for PRES.
• Understanding the pathophysiology, risk factors, and clinical/radiographic patterns is crucial for timely diagnosis and management of PRES.
• PRES can be triggered by altered cerebral blood flow or endothelial damage, especially in individuals with a compromised blood-brain barrier.