Posterior Reversible Encephalopathy Syndrome Following Intracranial Hypotension Due to Cerebrospinal Fluid (CSF) Leakage: A Report of Two Cases

Abdullah Darwish,Elham Rawah,Ibrahim Elsodany,Zaina Brinji,Omar Alserihy

doi:10.7759/cureus.17841

Abstract

Posterior reversible encephalopathy syndrome (PRES) in cases of intracranial hypotension is a life-threatening condition. Early suspicion, appropriate treatment, and tight control of possible contributing factors that may facilitate PRES in cerebrospinal fluid (CSF) leak patients may bring a more favorable outcome, lowering the morbidity and mortality rate.Two cases of PRES with features of intracranial hypotension are presented.We also discussed the possible pathogenesis of PRES in patients with intracranial hypotension. We emphasize the importance of the early diagnosis and treatment of ICH by repairing the leakage and further prompt attention to tight blood pressure control in those patients to avoid PRES development.

Highlights

Posterior reversible encephalopathy syndrome (PRES) is a clinical neuroradiological syndrome of heterogeneous etiologies characterized by unique neurological symptoms and radiological findings
It is considered a variant of hypertensive encephalopathy and referred to as hyperperfusion encephalopathy or reversible posterior leukoencephalopathy syndrome (RPLS). [1]
The syndrome may occur due to acute severe systemic hypertension, but it has been associated with preeclampsia/eclampsia, drug toxicity, thrombotic microangiopathies, uremic encephalopathies, and sepsis

Summary

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a clinical neuroradiological syndrome of heterogeneous etiologies characterized by unique neurological symptoms and radiological findings. It is considered a variant of hypertensive encephalopathy and referred to as hyperperfusion encephalopathy or reversible posterior leukoencephalopathy syndrome (RPLS). It is clinically characterized by headache, visual disturbances, seizures, and altered mental function [2]. Intracranial hypotension, is not known to be an etiology for this condition. We report two cases of patients who presented with radiological and clinical manifestation of intracranial hypotension complicated by PRES after being subjected to spinal surgery. The syndrome may occur due to acute severe systemic hypertension, but it has been associated with preeclampsia/eclampsia, drug toxicity, thrombotic microangiopathies, uremic encephalopathies, and sepsis

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