Posterior Reversible Encephalopathy Syndrome and Subarachnoid Hemorrhage After Lumboperitoneal Shunt for Fulminant Idiopathic Intracranial Hypertension

Fok, Anthony; Chandra, Ronil V.; Gutman, Matthew; Ligtermoet, Matthew; Seneviratne, Udaya; Kempster, Peter

doi:10.1097/wno.0000000000000355

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…In most cases Figure 2, no intra-operative complications were reported in the selected studies. We found that there was a higher percentage for certain types of surgery, such as in the case of neurosurgical pathology [16,24,28,29,32], both cranial and spinal [15,18,19,36,42,49]. In some cases, the risk factor for PRES was sustained by hypertension caused by incomplete postoperative pain control [67].…”

Section: Discussionmentioning

confidence: 91%

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

et al. 2023

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Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms’ onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4–82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases.

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Section: Discussionmentioning

confidence: 91%

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

et al. 2023

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“…In fact, cases with a high risk of severe CSF leak, such as in epidural catheter migration,[27] continuous lumbar drainage after spinal surgery,[13] and lumbar drainage for incisional effusion after spinal surgery,[32] were reported to antedate PRES, which is similar to situation described here in Case 1. In addition, the emergence of PRES after surgeries, such as VP shunt,[12] lumbo-peritoneal shunt,[8] and posterior fossa tumors with obstructed hydrocephalus,[211232633] have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Rapid intracranial pressure drop as a cause for posterior reversible encephalopathy syndrome: Two case reports

Niwa¹,

Oya²,

Nakamura³

et al. 2017

Surg Neurol Int

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Background:Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible edematous lesions on radiological examinations as well as symptoms of altered consciousness and seizures. To date, the underlying mechanism remains largely unknown.Case Descriptions:Case 1 is a 72-year-old man with a history of hypertension presented with a subarachnoid hemorrhage. Fourteen days after the successful clipping of a ruptured aneurysm; he experienced inadvertent overdrainage via the intraventricular drain. Nine hours later, he started to have seizures followed by disturbances in consciousness. An emergency magnetic resonance imaging showed multiple high-intensity lesions in the frontal, temporal, parietal, and occipital lobes, basal ganglia, brainstem, and cerebellar hemispheres bilaterally, which are compatible with typical magnetic resonance findings in PRES patients. He was treated conservatively and recovered well. Case 2 is a 68-year-old woman with a mild history of hypertension and a ventriculo-peritoneal shunt for obstructive hydrocephalus, who underwent a cysto-peritoneal shunt placement because of an enlarging symptomatic arachnoid cyst. Immediately following surgery, she experienced disturbances in consciousness and developed status epilepticus. Radiological examinations revealed remarkable shrinkage of the arachnoid cyst and multiple edematous lesions, which led us to strongly suspect PRES. With conservative treatment, her symptoms and the radiological abnormalities disappeared.Conclusion:Based on the previous literature and our cases, we believe that the association between rapid reduction of intracranial pressure (ICP) and the development of PRES should be recognized because most neurosurgical procedures such as craniotomy or cerebrospinal fluid diversion present a potential risk of rapid reduction of ICP.

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“…Atypical clinical presentations including non-orthostatic headaches, visual defects, neurocognitive decline, epilepsy, and focal neurological deficits, which are similar to PRES, have already been reported. Recently, the association between PRES and CSF hypovolemia has started to emerge in the neurology (9)(10)(11)(12)(13)(14)(15)(16)(17), neurosurgery (18)(19)(20)(21)(22)(23)(24), and anesthesiology literature (10-13, 16, 19, 25-35). However, the association between PRES and CSF hypovolemia has not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Hypovolemia and Posterior Reversible Encephalopathy Syndrome

Zheng

Weng

et al. 2020

Front. Neurol.

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Posterior reversible encephalopathy syndrome (PRES) is a reversible neuroradiological syndrome characterized by reversible vasogenic edema. The pathophysiological mechanism is still unclear, but PRES may be triggered by various etiologies. To date, only a few PRES cases linked to cerebrospinal fluid (CSF) hypovolemia were reported. The association between PRES and CSF hypovolemia needs to be explored. We presented a case of PRES with CSF hypovolemia as a result of an inadvertent dural puncture and reviewed the literature to identify the clinical characterization and pathophysiological mechanism of PRES following CSF hypovolemia. A total of 31 cases of PRES-CSF hypovolemia was included for analysis. The median age was 33 years, with a notable female predominance (87.1%). Fifteen patients (48.4%) didn't have either a history of hypertension nor an episode of hypertension. The most common cause of CSF hypovolemia was epidural or lumbar puncture (n = 21), followed by CSF shunt (n = 6). The median interval between the procedure leading to CSF hypovolemia and PRES was 4 days. Seizure, altered mental state, and headache were the most frequent presenting symptom. The parietooccipital pattern was most frequent (71.0%). Conservative management remains the mainstay of treatment with excellent outcomes. Three patients had a second episode of PRES. CSF hypovolemia is a plausible cause of PRES via a unique pathophysiologic mechanism including arterial hyperperfusion and venous dysfunction. Patients with CSF hypovolemia is more susceptible to PRES, which is potentially life-threatening. Given that CSF hypovolemia is a common complication of anesthetic, neurological, and neurosurgical procedures, PRES should be early considered for prompt diagnosis and appropriate management.

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Posterior Reversible Encephalopathy Syndrome and Subarachnoid Hemorrhage After Lumboperitoneal Shunt for Fulminant Idiopathic Intracranial Hypertension

Cited by 6 publications

References 12 publications

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?

Rapid intracranial pressure drop as a cause for posterior reversible encephalopathy syndrome: Two case reports

Cerebrospinal Fluid Hypovolemia and Posterior Reversible Encephalopathy Syndrome

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