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. 2025 Oct 25.
doi: 10.1007/s13760-025-02924-7. Online ahead of print.

Pseudohypoxic brain swelling in a case of acute craniospinal hypotension

Nina Nagels  1 , Margot Ghesquière  2   3 , Thomas Claeys  2 , Niels Libbrecht  2 , Kristof Ramboer  4   5
Affiliations

Pseudohypoxic brain swelling in a case of acute craniospinal hypotension

Nina Nagels et al. Acta Neurol Belg. .

Abstract

Pseudohypoxic brain swelling (PHBS) also known as postoperative hypotension-associated venous congestion is a serious and poorly understood postoperative complication associated with rapid postoperative deterioration. Imaging findings include acute diffuse brain swelling and flair hyperintense changes in the basal ganglia making misidentification with hypoxic ischemic encephalopathy an important pitfall. This case represents a rare example of this entity with objective volumetric confirmation for the first time as well as an incomplete lentiform fork sign. The findings question one of the current hypotheses involving brain sagging [1]. Recognition of this radiological pattern is essential for differentiation from hypoxic or metabolic encephalopathies and may guide appropriate management.

Keywords: Intracranial hypotension; Monro-Kellie doctrine; Postoperative hypotension-associated venous congestion; Pseudohypoxic brain swelling.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics and consent to participate declarations: No ethics approval or informed consent was required.

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