Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.
Department of Radiology, University Hospital of Ioannina, Ioannina, Greece.
Int J Neurosci. 2020 Nov;130(11):1174-1177. doi: 10.1080/00207454.2020.1730365. Epub 2020 Feb 18.
To present an unusual case of posterior encephalopathy syndrome (PRES) preceded by intracranial hypotension. We present a case of a 27-year-old parturient with an uneventful pregnancy that shortly after labor developed a persistent headache with characteristics compatible with intracranial hypotension. The patient had undergone epidural anesthesia for caesarian section. The symptomatology of intracranial hypotension was attributed to inadvertent dural puncture during epidural anesthesia. The MRI revealed multiple white matter lesions located in frontal, temporal and parietal regions of both hemispheres. The type of lesions was suggestive of PRES. Pachymeningeal enhancement was also observed. The patient was managed conservatively. The symptoms improved gradually and the imaging findings resolved completely. This case demonstrates the need for clinical alertness for PRES in patients with prolonged and possibly atypical symptoms of intracranial hypotension. As probable causal relationship between these disorders we propose a sympathetic over-activation as a result of cerebrospinal fluid leakage leading to vasospasm and manifestation of PRES.
现报告一例颅内低压（intracranial hypotension，IH）继发的后部脑病综合征（posterior encephalopathy syndrome，PRES）。我们报告了一例 27 岁产妇，妊娠过程顺利，产后不久即出现持续性头痛，伴有与颅内低压相符的特征。患者因剖宫产而行硬膜外麻醉。IH 的症状归因于硬膜外麻醉时的意外硬脊膜穿刺。MRI 显示双侧额、颞、顶叶多发脑白质病变，病变类型提示 PRES。硬脑膜强化也有观察到。患者接受了保守治疗。症状逐渐改善，影像学表现完全消退。该病例表明，对于 IH 患者，即使症状延长且可能不典型，也需要保持对 PRES 的临床警觉。我们提出，脑脊液漏导致交感神经过度激活，继而引发血管痉挛和 PRES 发病，这可能是这两种疾病之间的因果关系。
