Niwa Ryoko, Oya Soichi, Nakamura Takumi, Hana Taijun, Matsui Toru
Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Surg Neurol Int. 2017 Jun 5;8:103. doi: 10.4103/sni.sni_55_17. eCollection 2017.
Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible edematous lesions on radiological examinations as well as symptoms of altered consciousness and seizures. To date, the underlying mechanism remains largely unknown.
Case 1 is a 72-year-old man with a history of hypertension presented with a subarachnoid hemorrhage. Fourteen days after the successful clipping of a ruptured aneurysm; he experienced inadvertent overdrainage via the intraventricular drain. Nine hours later, he started to have seizures followed by disturbances in consciousness. An emergency magnetic resonance imaging showed multiple high-intensity lesions in the frontal, temporal, parietal, and occipital lobes, basal ganglia, brainstem, and cerebellar hemispheres bilaterally, which are compatible with typical magnetic resonance findings in PRES patients. He was treated conservatively and recovered well. Case 2 is a 68-year-old woman with a mild history of hypertension and a ventriculo-peritoneal shunt for obstructive hydrocephalus, who underwent a cysto-peritoneal shunt placement because of an enlarging symptomatic arachnoid cyst. Immediately following surgery, she experienced disturbances in consciousness and developed status epilepticus. Radiological examinations revealed remarkable shrinkage of the arachnoid cyst and multiple edematous lesions, which led us to strongly suspect PRES. With conservative treatment, her symptoms and the radiological abnormalities disappeared.
Based on the previous literature and our cases, we believe that the association between rapid reduction of intracranial pressure (ICP) and the development of PRES should be recognized because most neurosurgical procedures such as craniotomy or cerebrospinal fluid diversion present a potential risk of rapid reduction of ICP.
后部可逆性脑病综合征（PRES）的特征是在影像学检查中出现可逆性水肿性病变，以及意识改变和癫痫发作症状。迄今为止，其潜在机制仍 largely 未知。
病例 1 是一名 72 岁男性，有高血压病史，出现蛛网膜下腔出血。在成功夹闭破裂动脉瘤 14 天后；他通过脑室内引流管意外过度引流。9 小时后出现癫痫发作，随后意识障碍。紧急磁共振成像显示双侧额叶、颞叶、顶叶、枕叶、基底神经节、脑干和小脑半球有多个高强度病变这与 PRES 患者典型的磁共振表现相符。他接受了保守治疗，恢复良好病例 2 为一名 68 岁女性有轻度高血压病史，因梗阻性脑积水行脑室 - 腹腔分流术，因症状性蛛网膜囊肿增大行囊肿 - 腹腔分流术。手术后立即出现意识障碍并发展为癫痫持续状态。影像学检查显示蛛网膜囊肿明显缩小和多个水肿性病变强烈怀疑为 PRES。经保守治疗她的症状和影像学异常消失。
根据既往文献和我们的病例，我们认为应认识到颅内压（ICP）快速降低与 PRES 发生之间的关联因为大多数神经外科手术如开颅手术或脑脊液分流术都存在 ICP 快速降低的潜在风险。
