Post-partum posterior reversible encephalopathy syndrome requiring decompressive craniectomy: case report and review of the literature.
Acta Neurochir (Wien)
; 161(2): 217-224, 2019 02.
Article
em En
| MEDLINE
| ID: mdl-30659351
ABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis. Despite initial conservative therapy including anti-epileptic drugs, magnesium therapy, empiric antibiotics, and Trendelenburg positioning, the patient continued to deteriorate. Follow-up imaging was suggestive of PRES with signs of intracranial hypertension. The patient underwent a decompressive suboccipital craniectomy for refractory and severe PRES and later fully recovered. This case highlights the sometimes difficult diagnosis of PRES, possible association with pregnancy, eclampsia/preeclampsia and/or cerebrospinal fluid drainage, and the rare but life-saving need for decompression in severe cases.
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Base de dados:
MEDLINE
Assunto principal:
Período Pós-Parto
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Síndrome da Leucoencefalopatia Posterior
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Craniectomia Descompressiva
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article