A Case Report on Cerebral Autoregulation in Posterior Reversible Encephalopathy Syndrome After Aneurysmal...

Disturbed cerebral autoregulation remains a theoretical contributor to posterior reversible encephalopathy syndrome (PRES), but it has not been captured before. We report invasively measured autoregulation indices in a 50-year-old female with aneurysmal subarachnoid hemorrhage.

PRES developed after induced hypertension and intra-arterial nimodipine infusion as treatment for delayed cerebral ischemia. The poorest autoregulation values were observed a week before PRES, at the time of delayed cerebral ischemia and sepsis. A second, less pronounced deterioration of autoregulation occurred before PRES diagnosis. Relevant comorbidities potentially related to PRES were fetal-type arterial supply to the posterior circulation, pneumonia, and steroid application.

This is the first reported case with cerebral autoregulation measurements during PRES. Hypothetically, autoregulation could have contributed to PRES in a setting of persistent hypertension, immunological factors, and a more susceptible posterior circulation. Further data are required to reliably investigate the relationship between autoregulation and PRES.