Posterior Reversible Encephalopathy Syndrome after Surgical Resection of a Giant Vestibular Schwannoma

Case Report and Literature Review

Mohammad Sorour, Christina Sayama, William T. Couldwell

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms—seizures, headaches, altered mental status, and visual changes—associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences. Classically, this condition is caused by hypertension, but several other risk factors have been described. The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice. Case Report We report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. Conclusion PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome.

Original languageEnglish (US)
JournalJournal of Neurological Surgery, Part A: Central European Neurosurgery
DOIs
StateAccepted/In press - Feb 25 2015
Externally publishedYes

Fingerprint

Posterior Leukoencephalopathy Syndrome
Acoustic Neuroma
Infratentorial Neoplasms
Sequence Inversion
Anticonvulsants
Antihypertensive Agents
Nervous System
Brain Stem
Headache
Magnetic Resonance Imaging
Pediatrics
Hypertension
Brain
Neoplasms

Keywords

  • acoustic neuroma
  • hypertension
  • posterior fossa
  • posterior reversible encephalopathy syndrome
  • vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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title = "Posterior Reversible Encephalopathy Syndrome after Surgical Resection of a Giant Vestibular Schwannoma: Case Report and Literature Review",
abstract = "Background Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms—seizures, headaches, altered mental status, and visual changes—associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences. Classically, this condition is caused by hypertension, but several other risk factors have been described. The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice. Case Report We report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. Conclusion PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome.",
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N2 - Background Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms—seizures, headaches, altered mental status, and visual changes—associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences. Classically, this condition is caused by hypertension, but several other risk factors have been described. The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice. Case Report We report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. Conclusion PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome.

AB - Background Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms—seizures, headaches, altered mental status, and visual changes—associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences. Classically, this condition is caused by hypertension, but several other risk factors have been described. The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice. Case Report We report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. Conclusion PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome.

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