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Posterior reversible encephalopathy syndrome presenting in the anterior circulation with malignant intracranial hypertension requiring surgical decompression: a case report and literature review

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is thought to result from endothelial dysfunction and breakdown of the blood–brain barrier with subsequent vasogenic edema. Abrupt hypertension has been identified as one of its risk factors. We present a rare case of PRES in the anterior circulation with sudden onset of left hemiparesis and rapid neurological deterioration on the basis of hypertensive crisis. Due to refractory intracranial hypertension, the patient required emergent right decompressive craniectomy. Further investigations, including a biopsy, revealed an atypical form of PRES. This case illustrates the importance of aggressive medical and early surgical management to prevent permanent neurological deficits.

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Authors and Affiliations

  1. Department of Neurological Surgery, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    S. Hernández-Durán, V. Rohde & C. von der Brelie

  2. Department of Neuropathology, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    A. Barrantes-Freer

Authors
  1. S. Hernández-Durán
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  2. A. Barrantes-Freer
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  3. V. Rohde
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  4. C. von der Brelie
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Corresponding author

Correspondence to S. Hernández-Durán.

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The authors declare no conflicts of interest. The patient has consented to submission of this case report to the journal.

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Comments

The case report describes one severe case with PRES involving the frontal lobes. The patient was managed successfully according to modern neurointensive care (NIC) principles and finally operated with decompressive hemicraniectomy. It is important that the neurosurgeons are aware of the PRES condition even if it is a rare diagnosis. The case report is a good illustration that NIC has an important place in the management of the more severe cases as well as neurosurgical treatment.

Per Enblad

Uppsala, Sweden

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Hernández-Durán, S., Barrantes-Freer, A., Rohde, V. et al. Posterior reversible encephalopathy syndrome presenting in the anterior circulation with malignant intracranial hypertension requiring surgical decompression: a case report and literature review. Acta Neurochir 159, 1321–1324 (2017). https://doi.org/10.1007/s00701-017-3197-x

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  • DOI: https://doi.org/10.1007/s00701-017-3197-x

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