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Posterior reversible encephalopathy syndrome (PRES): a rare condition after resection of posterior fossa tumors: two new cases and review of the literature

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An Erratum to this article was published on 01 March 2016

Abstract

Introduction

In 1996, Hinchey and colleagues coined the term “Posterior reversible encephalopathy syndrome” (PRES) to describe a condition seen in patients with acute neurological symptoms and reversible subcortical vasogenic edema predominantly involving parieto-occipital areas demonstrated in brain MRI. The occurrence of this phenomenon after surgical resection of CNS tumors is typically linked to pediatric cases.

Material and Methods

Two new cases of PRES after posterior fossa surgery are reported. A thorough review of the literature is carried out with the purpose of updating and summarizing the main features regarding PRES in similar cases. Seven cases ofPRES after resection of a posterior fossa tumor have been hitherto reported (4 patients were <20 years old). Thereis another pediatric case described after a ventriculoperitoneal shunting procedure in a patient with fourth ventricleependymoma. Two resected tumors were ependymomas, 2 hemangiopericytomas in one patient, 1 pilocyticastrocytoma, 1 vestibular schwannoma, and 1 of the reported cases did not describe the final pathology diagnosis.

Case Reports

We present 2 new cases of PRES after surgical resection of a posterior fossa tumor (medulloblastoma in case 1and ependymoma in case 2) in pediatric patients. Case 1 developed delayed seizures and altered mental status(10 days after surgical resection) after receiving treatment with bromocriptine for cerebellar mutism. Case 2presented with generalized seizures and altered mental status within the first 48 postoperative hours followed byright hemiparesis. Both patients fully recovered and returned to neurological baseline status. A thorough review ofthe literature was carried out with the purpose of updating and summarizing the main features regarding PRES insimilar cases.

Conclusions

We report 2 new pediatric cases of posterior reversible encephalopathy syndrome (PRES) that developed after surgical resection of a posterior fossa tumor. Appropriate management includes supportive measures, antihypertensive agents, and antiepileptic drugs, if needed. Full recovery is the most likely outcome in line with previous articles.

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References

  1. Hinchey J, Chaves C, Appignani B, et al. (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334(8):494–500. doi:10.1056/NEJM199602223340803

    Article  CAS  PubMed  Google Scholar 

  2. Staykov D, Schwab S (2012) Posterior reversible encephalopathy syndrome. J Intensive Care Med 27(1):11–24. doi:10.1177/0885066610393634

    Article  PubMed  Google Scholar 

  3. Siebert E, Bohner G, Endres M, Liman TG (2014) Clinical and radiological spectrum of posterior reversible encephalopathy syndrome: does age make a difference?–A retrospective comparison between adult and pediatric patients. PloS one 9(12):e115073. doi:10.1371/journal.pone.0115073 eCollection 2014

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fugate JE, Rabinstein AA (2015) Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 14(9):914–925. doi:10.1016/S1474-4422(15)00111-8

    Article  PubMed  Google Scholar 

  5. Moriarity Jr JL, Lim M, Storm PB, Beauchamp Jr NJ, Olivi A (2001) Reversible posterior leukoencephalopathy occurring during resection of a posterior fossa tumor: case report and review of the literature. Neurosurgery 49(5):1237–1239 discussion 1239–1240

    PubMed  Google Scholar 

  6. Patel AJ, Fox BD, Fulkerson DH, et al. (2010) Posterior reversible encephalopathy syndrome during posterior fossa tumor resection in a child. J Neurosurg Pediatr 6(4):377–380. doi:10.3171/2010.8.PEDS10110

    Article  PubMed  Google Scholar 

  7. Gephart MG, Taft BP, Giese AK, Guzman R, Edwards MS (2011) Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma. J Neurosurg Pediatr 7(3):235–237. doi:10.3171/2010.12.PEDS10299

    Article  PubMed  Google Scholar 

  8. Sánchez-cuadrado LL, Royo A, Cerdeño V, Roda JM, Gavilán J (2011) Reversible posterior leukoencephalopathy syndrome alter lateral skull base surgery. Otol Neurotol. 32(5):838–840. doi:10.1097/MAO.0b013e31821f1b95

    Article  PubMed  Google Scholar 

  9. Avecillas-Chasín JM, Gómez G, Jorquera M, Alvarado LR, Barcia JA (2013) Delayed posterior reversible encephalopathy syndrome (PRES) after posterior fossa surgery. Acta Neurochir (Wien) 155(6):1045–1047. doi:10.1007/s00701-013-1690-4

    Article  Google Scholar 

  10. Kuhnt D, Becker A, Benes L, Nimsky C (2013) Reversible cortical blindness and internuclear ophthalmoplegia after neurosurgical operation: case report and review of the literature. J Neurol Surg A Cent Eur Neurosurg 74(Suppl 1):e128–e132. doi:10.1055/s-0032-1327448

    PubMed  Google Scholar 

  11. Sorour M, Sayama C, Couldwell WT. (2015) Posterior reversible encephalopathy syndrome after surgical resection of a giant vestibular schwannoma: case report and literature review. J Neurol Surg A Cent Eur Neurosurg

  12. Kamiya-Matsuoka C, Cachia D, Olar A, Armstrong TS, Gilbert MR (2014) Primary brain tumors and posterior reversible encephalopathy syndrome. Neurooncol Pract 1(4):184–190

    PubMed  PubMed Central  Google Scholar 

  13. Kan P, Couldwell WT (2006) Posterior fossa brain tumors and arterial hypertension. Neurosurg Rev 29(4):265–269 discussion 269

    Article  PubMed  Google Scholar 

  14. Geiger H, Naraghi R, Schobel HP, Frank H, Sterzel RB, Fahlbusch R ((1998)) Decrease of blood pressure by ventrolateral medullary decompression in essential hypertension. Lancet 352(9126):446–449. doi:10.1016/S0140-6736(97)11343-5

    Article  CAS  PubMed  Google Scholar 

  15. Tayyab Rehman MD et al. (2015) Posterior reversible encephalopathy syndrome. Am J Med Sci. 349(3):244. doi:10.1097/MAJ.0000000000000198

    Article  PubMed  Google Scholar 

  16. Hugonneta E, Da Inesa D, Bobyb H, Claise S B, Petitcolin A V, Lannareixa V, Garciera JM (2013) Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagnostic and Interventional Imaging 94:45–52. doi:10.1016/j.diii.2012.02.005

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Hospital General 12 de Octubre, Madrid, Spain

    Lain Hermes González Quarante, José Hinojosa Mena-Bernal, Beatriz Pascual Martín, Marta Ramírez Carrasco & María Jesús Muñoz Casado

  2. Department of Neuroradiology, Hospital General 12 de Octubre, Madrid, Spain

    Ana Martínez de Aragón

  3. Department of Pediatric Neurology, Hospital General 12 de Octubre, Madrid, Spain

    Rogelio Simón de las Heras

  4. Department of Neurosurgery, HGU Gregorio Marañón, Calle Doctor Esquerdo número 46, C.P, 28007, Madrid, Spain

    Lain Hermes González Quarante

Authors
  1. Lain Hermes González Quarante
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  2. José Hinojosa Mena-Bernal
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  3. Beatriz Pascual Martín
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  5. María Jesús Muñoz Casado
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  6. Ana Martínez de Aragón
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  7. Rogelio Simón de las Heras
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Correspondence to Lain Hermes González Quarante.

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Quarante, L.H.G., Mena-Bernal, J.H., Martín, B.P. et al. Posterior reversible encephalopathy syndrome (PRES): a rare condition after resection of posterior fossa tumors: two new cases and review of the literature. Childs Nerv Syst 32, 857–863 (2016). https://doi.org/10.1007/s00381-015-2954-5

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  • DOI: https://doi.org/10.1007/s00381-015-2954-5

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