Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis &amp;ndash;&amp;nbsp;a case report

Shah, Reena; Kubisz-Pudelko, Agnieszka

doi:10.2147/lra.s57660

Cited by 20 publications

(10 citation statements)

References 17 publications

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“…Therefore, when diagnosing PDPH in obstetric patients, it is important to exclude other causes of headache, such as functional headaches. Less frequent complications of accidental dural puncture include reversible encephalopathy [111213], pneumocephalus [14], and subdural hematoma [1516]. Therefore, when neurological signs or changes in headache characteristics such as non-postural headache occur, serious etiologies should be excluded such as subdural hematoma, cerebral thrombosis, and reversible encephalopathy [17].…”

Section: Clinical Symptoms and Diagnosismentioning

confidence: 99%

Postdural puncture headache

Kwak

2017

Korean J Anesthesiol

138

128

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Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.

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Section: Clinical Symptoms and Diagnosismentioning

confidence: 99%

Postdural puncture headache

Kwak

2017

Korean J Anesthesiol

138

128

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“…Twelve cases were associated with a spinal tap or epidural anesthesia. [6121315162225272931323334] Although not all of the above-mentioned reports directly described a relationship between ICP and PRES, these cases indicate a strong association between PRES and a rapid reduction in ICP. 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.…”

Section: Discussionmentioning

confidence: 98%

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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“…2 Of note, unlike these classic theories, the pathophysiology of PRES during episodes of intracranial hypotension has been associated with both arterial and venous dysfunction. [4][5][6] Regarding arterial abnormalities, several cases suggest that downward displacement of the brain in SIH, along with the subsequent release of chemical and neurogenic factors, can cause transient multifocal vasoconstriction of large and medium-sized arteries. 4,7 This segmental arterial sclerosis, known as reversible cerebral vasoconstriction syndrome (RCVS), results in transient episodes of ischemia and vasogenic edema.…”

Section: Oy-stersmentioning

confidence: 99%

“…9 We found only 3 case reports of intracranial hypotension and PRES following CSF leak that have directly cited venous dysfunction in the pathogenesis of PRES. [4][5][6] Two mechanisms could explain this phenomenon. First, brain perfusion depends on both systemic mean arterial pressure (MAP) and intracranial pressure (ICP), the difference of which determines cerebral perfusion pressure (CPP): CPP 5 MAP 2 ICP.…”

Section: Oy-stersmentioning

confidence: 99%

Pearls & Oy-sters: Spontaneous intracranial hypotension and posterior reversible encephalopathy syndrome

2016

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Pearls & Oy-sters: Spontaneous intracranial hypotension and posterior reversible encephalopathy syndrome PEARLS• Although rare, cases of posterior reversible encephalopathy syndrome (PRES) secondary to CSF leak and intracranial hypotension have been documented in the literature.• The pathogenesis of PRES in these settings has been associated with both arterial and venous cerebrovascular dysfunction. OY-STERS• PRES should be suspected in patients with CSF leak who continue to experience headache, visual changes, and altered mentation despite conservative management.• The mainstay of treatment involves resolution of the CSF leak, typically with an autologous epidural blood patch.CASE REPORT A 65-year-old woman with no significant medical history was brought to the emergency room after experiencing 2 weeks of band-like occipital headaches and 2 days of progressive mental status changes. Her neurologic examination was significant for decreased alertness, disorientation to time, confabulation, loss of recent and remote memory, diffuse hyperreflexia, and a left Hoffmann sign. MRI of the brain with contrast showed bilateral subdural hygromas, diffuse enhancement of the dura mater, with mild sagging of the brainstem suggestive of intracranial hypotension (figure 1, A and B). MRI of the spine showed a large collection of CSF in the lumbar epidural space ( figure 2A); however, the tear site was not identified. EEG also revealed generalized slowing with no evidence of seizure activity. Her mental status continued to deteriorate despite conservative measures such as aggressive hydration, caffeine intake, and bedrest in the Trendelenburg position. A head CT was ordered for worsening mental status and revealed symmetric hypoattenuation of the bilateral parasagittal occipital cortices consistent with PRES ( figure 2B), a finding that was not present on the initial MRI. She then received an emergent lumbar epidural blood patch, resulting in dramatic improvement in mental status several hours later. She was discharged without any focal neurologic deficits. An MRI performed 10 days later revealed no evidence of PRES in the occipital region. An MRI of the lumbar spine performed 5 weeks later showed resolution of the fluid collection (figure 3).DISCUSSION Spontaneous intracranial hypotension (SIH) is a known neurologic condition characterized by occipital headaches, neck stiffness, and altered mentation that results from leakage of CSF through a structural break in the meninges. Distinct abnormalities on MRI support the diagnosis, including diffuse meningeal enhancement, subdural fluid collections, engorgement of the dural sinuses, and downward displacement of the brain that can result in compression of vital structures (figure 1, A and B). Stupor and coma, for example, have been linked to compression of the diencephalon. 1 While our patient's altered mental status was initially attributed to brain sagging, her clinical deterioration was complicated by a transient occipital hypodensity concerning for PRES (figure 2B). Although rare...

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Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis – a case report

Cited by 20 publications

References 17 publications

Postdural puncture headache

Postdural puncture headache

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

Pearls & Oy-sters: Spontaneous intracranial hypotension and posterior reversible encephalopathy syndrome

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