RESUMEN
Hemodynamic augmentation is the primary medical intervention employed to reverse neurological deficits associated with vasospasm and delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. Failure to improve despite induced hypertension (IH) may raise concern for persistent hypoperfusion and prompt even more aggressive blood pressure augmentation. However, posterior reversible encephalopathy syndrome (PRES) is a hyperperfusion syndrome reported as a rare complication of IH that may confound this picture. We report a case of PRES with prominent thalamic involvement and impaired level of consciousness secondary to blood pressure augmentation for the treatment of symptomatic vertebrobasilar vasospasm. Recognition of this syndrome in distinction to worsening ischemia is particularly critical, as normalization of blood pressure should lead to rapid clinical improvement.
Asunto(s)
Síndrome de Leucoencefalopatía Posterior/inducido químicamente , Síndrome de Leucoencefalopatía Posterior/terapia , Hemorragia Subaracnoidea/complicaciones , Tálamo/fisiopatología , Vasoconstrictores/efectos adversos , Vasoespasmo Intracraneal/tratamiento farmacológico , Presión Sanguínea , Trastornos de la Conciencia/inducido químicamente , Diagnóstico Diferencial , Epilepsia Tónico-Clónica/inducido químicamente , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fenilefrina/efectos adversos , Fenilefrina/uso terapéutico , Síndrome de Leucoencefalopatía Posterior/diagnóstico por imagen , Tálamo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vasoconstrictores/uso terapéutico , Vasoespasmo Intracraneal/complicaciones , Vasoespasmo Intracraneal/etiologíaRESUMEN
Hemodynamic augmentation is the primary medical intervention employed to reverse neurological deficits associated with vasospasm and delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. Failure to improve despite induced hypertension (IH) may raise concern for persistent hypoperfusion and prompt even more aggressive blood pressure augmentation. However, posterior reversible encephalopathy syndrome (PRES) is a hyperperfusion syndrome reported as a rare complication of IH that may confound this picture. We report a case of PRES with prominent thalamic involvement and impaired level of consciousness secondary to blood pressure augmentation for the treatment of symptomatic vertebrobasilar vasospasm. Recognition of this syndrome in distinction to worsening ischemia is particularly critical, as normalization of blood pressure should lead to rapid clinical improvement.