Posterior reversible encephalopathy syndrome with lumbar drainage and surgery: coincidence or correlation? A case report

• Published in: BMC neurology Vol. 19; no. 1; p. 214
• Main Authors: Oxford, Brent G, Khattar, Nicolas K, Adams, Shawn W, Schaber, Alexandra S, Williams, Brian J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.08.2019; BioMed Central; BMC
• Subjects: Blood pressure; Blood-brain barrier; Care and treatment; Case Report; Case reports; Case studies; CAT scans; Cerebellum; Cerebrospinal fluid; Cysts; Diagnosis; Edema; Encephalopathy; Headache; Homeostasis; Hyperemia; Hypertension; Hypotension; Intracranial hypotension; Lumbar drain; Magnetic resonance imaging; Medical errors; Medical schools; Nervous system diseases; NMR; Nuclear magnetic resonance; Patients; Posterior reversible encephalopathy syndrome; Sellar mass; Surgery; Intracranial hypotension; Sellar mass; Lumbar drain; Posterior reversible encephalopathy syndrome
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-019-1438-8

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder usually associated with specific medical conditions that cause a disturbance of the CNS homeostasis. It has seldom been reported to be a consequence of an iatrogenic intervention causing intracranial hypotension. We report the case of an individual 69-year-old male presenting with headache and blurred vision following cerebrospinal fluid (CSF) leak from resection of a sellar mass. The patient developed the condition following removal of the lumbar drain post-operatively. Magnetic Resonance Imaging showed bilateral occipital, parieto-occipital, and cerebellar T2 FLAIR hyper-intensities, suggesting a radiological diagnosis of posterior reversible encephalopathy syndrome (PRES). The patient's symptoms started to improve shortly afterwards and had completely resolved at 3 months follow-up. The absence of severe hypertension and presence of an intraoperative CSF leak requiring placement of the lumbar drain suggests that decreased CSF volume and associated reactive hyperemia could have a role in the pathophysiology of the disease.