Tokunaga Shinya, Arai Daisuke, Yamashita Tomoyuki, Sato Tsukasa
Department of Neurosurgery, Medical Research Institute, Kitano Hospital, Osaka.
Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Japan.
Surg Neurol Int. 2025 May 2;16:160. doi: 10.25259/SNI_216_2025. eCollection 2025.
Posterior reversible encephalopathy syndrome (PRES) is characterized by transient vasogenic edema, predominantly affecting the white matter in the posterior cerebral hemispheres. It presents with acute neurological symptoms such as headaches, visual disturbances, and seizures. The pathophysiology of PRES, including its overlap with contrast-induced encephalopathy and transient cortical blindness, remains unclear.
A 76-year-old woman with a basilar artery aneurysm underwent diagnostic angiography. During the procedure, she experienced a hypertensive spike following the injection of contrast medium. Four hours post-angiography, she developed disorientation and bilateral light perception, which progressed to complete blindness. Magnetic resonance imaging revealed bilateral occipital hemisphere edema, confirming a diagnosis of PRES. All neurological symptoms resolved within 48 h. Subsequently, she successfully underwent coil embolization of the aneurysm. With careful blood pressure management and a switch to a different type of contrast medium, PRES did not recur despite the use of a larger volume of contrast medium.
This case of contrast-induced PRES underscores the potential overlap in pathogenesis between PRES and contrast-induced encephalopathy. It emphasizes the need for careful blood pressure management and consideration of contrast medium type in patients undergoing angiography, especially those with a history of PRES. The successful management of this case provides valuable insights into the prevention and treatment of PRES in similar clinical scenarios.
后部可逆性脑病综合征（PRES）的特征是短暂性血管源性水肿，主要影响大脑后半球的白质。其表现为急性神经症状，如头痛、视觉障碍和癫痫发作。PRES的病理生理学，包括其与造影剂诱导的脑病和短暂性皮质盲的重叠，仍不清楚。
一名患有基底动脉瘤的76岁女性接受了诊断性血管造影。在手术过程中，她在注射造影剂后出现高血压峰值。血管造影术后4小时，她出现定向障碍和双侧光感，随后发展为完全失明。磁共振成像显示双侧枕叶水肿，确诊为PRES。所有神经症状在48小时内消失。随后，她成功接受了动脉瘤的弹簧圈栓塞术。通过仔细的血压管理和更换为不同类型的造影剂，尽管使用了更大剂量的造影剂，PRES并未复发。
该例造影剂诱导的PRES强调了PRES与造影剂诱导的脑病在发病机制上可能存在重叠。它强调了在接受血管造影的患者中，尤其是有PRES病史的患者，需要仔细管理血压并考虑造影剂类型。该病例的成功管理为类似临床情况下PRES的预防和治疗提供了有价值的见解。
