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Case Reports
. 2023 Mar 17:14:94.
doi: 10.25259/SNI_963_2022. eCollection 2023.

Hypertensive posterior reversible encephalopathy causing obstructive hydrocephalus

Saad Moughal  1 , Sana Ahmad  2 , Nayyar Saleem  1 , Chris Derham  3
Affiliations
Case Reports

Hypertensive posterior reversible encephalopathy causing obstructive hydrocephalus

Saad Moughal et al. Surg Neurol Int. .

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) can occur due to the detrimental effect of malignant hypertension on cerebral autoregulation. Most reported cases describe involvement of the supratentorial areas. Involvement of the posterior fossa structures in conjunction with supratentorial involvement has also been reported; however, PRES affecting the infratentorial structures without supratentorial involvement is a rare phenomenon. Clinical manifestations can involve severe headache, seizures, and reduced consciousness with treatment focused primarily on blood pressure control.

Case description: We report a case of PRES with isolated involvement of the infratentorial structures leading to obstructive hydrocephalus. The patient was managed with aggressive control of blood pressure and avoided ventriculostomy or posterior fossa decompression with a good outcome.

Conclusion: Medical management in the absence of neurological deficit can be associated with a good outcome.

Keywords: Cerebral autoregulation; Hypertensive encephalopathy; Obstructive hydrocephalus; Posterior fossa oedema.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Initial noncontrast axial computed tomography head scan demonstrating (a) cerebellar oedema with effacement of the fourth ventricle, (b and c) corresponding supratentorial ventriculomegaly.
Figure 2:
Figure 2:
Initial magnetic resonance imaging showing T2/fluid attenuated inversion recovery hyperintensities in the cerebellum and brainstem (a, b, and g) and dilated lateral ventricles with periventricular hyperintensity (c and d). No infarction on diffusion-weighted imaging (e) or enhancing lesion on contrast-enhanced T1 imaging (f).
Figure 3:
Figure 3:
Magnetic resonance imaging 6 weeks later demonstrating resolution of signal change and swelling of the infratentorial structures and improvement of hydrocephalus (a and c). Occasional T2 hyperintensities in supratentorial white matter persist, presumably due to mild small vessel disease (b).
See this image and copyright information in PMC

References

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