Posterior Reversible Encephalopathy Syndrome after Surgical Resection of a Giant Vestibular Schwannoma: Case Report and Literature Review.

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms-seizures, headaches, altered mental status, and visual changes-associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences. Classically, this condition is caused by hypertension, but several other risk factors have been described. The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice. We report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome.