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J Clin Neurosci. 2014 Feb;21(2):207-11. doi: 10.1016/j.jocn.2013.07.005. Epub 2013 Oct 11.

Hypertensive posterior reversible encephalopathy syndrome causing posterior fossa edema and hydrocephalus.

Author information

  • 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52245, USA. Electronic address: Andrew-grossbach@uiowa.edu.
  • 2Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52245, USA.

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a well characterized entity resulting from the inability of cerebral autoregulation to adequately protect the brain from uncontrolled hypertension. It primarily affects the occipital lobes, but can also involve the structures in the posterior fossa including the brainstem and cerebellum. Treatment usually consists of strict blood pressure control, but more aggressive management may be indicated with acutely worsening neurological status. We present a patient with hypertensive encephalopathy that resulted in hydrocephalus and brainstem compression necessitating surgical decompression requiring ventriculostomy and suboccipital craniectomy. In rare cases, PRES can present with severe brainstem compression requiring emergent posterior fossa decompression. When brainstem signs are present on exam, emergent posterior fossa decompression may be safer than ventriculostomy alone.

Copyright © 2013 Elsevier Ltd. All rights reserved.

KEYWORDS:

Cerebellar edema; Hypertensive encephalopathy; Suboccipital craniectomy

PMID:
24126039
[PubMed - indexed for MEDLINE]
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