Asymmetric posterior reversible encephalopathy syndrome complicating hemodynamic augmentation for subarachnoid hemorrhage-associated cerebral vasospasm

Autor: Thanh N. Nguyen, Alexander Norbash, Barbara Voetsch, Joseph D. Burns, Glenn D. Barest, Christina DeFusco, Deborah M. Green, Nicholas Tarlov
Rok vydání: 2011
Předmět:
Adult
medicine.medical_specialty
Middle Cerebral Artery
Subarachnoid hemorrhage
Blood Pressure
Critical Care and Intensive Care Medicine
Epilepsy
Aneurysm
Cerebral vasospasm
Imaging
Three-Dimensional
Recurrence
Internal medicine
Image Interpretation
Computer-Assisted
medicine
Humans
Vasospasm
Intracranial
cardiovascular diseases
Dominance
Cerebral
Neurologic Examination
medicine.diagnostic_test
business.industry
Stupor
Hemodynamics
Vasospasm
Posterior reversible encephalopathy syndrome
Intracranial Aneurysm
Subarachnoid Hemorrhage
medicine.disease
Magnetic Resonance Imaging
nervous system diseases
Cerebral Angiography
Paresis
Diffusion Magnetic Resonance Imaging
Regional Blood Flow
Anesthesia
cardiovascular system
Cardiology
Female
Neurology (clinical)
Epilepsy
Tonic-Clonic
Posterior Leukoencephalopathy Syndrome
medicine.symptom
business
Tomography
X-Ray Computed
Cerebral angiography
Zdroj: Neurocritical care. 15(3)
ISSN: 1556-0961
Popis: Posterior reversible encephalopathy syndrome (PRES) is a rare complication of hemodynamic augmentation for subarachnoid hemorrhage (SAH)-associated vasospasm. The roles of hyperperfusion and hypoperfusion in the genesis of PRES remain uncertain. Case report. We admitted a 35-year-old woman with Hunt & Hess grade II SAH secondary to rupture of a right middle cerebral artery (MCA) aneurysm. This was surgically clipped. Beginning on hospital day 3, she developed recurrent symptomatic vasospasm of the right MCA despite hemodynamic augmentation to a MAP as high as 130 mmHg and endovascular therapy. On hospital day 7, after 36 h of sustained MAP 120–130 mmHg, her level of arousal progressively declined, culminating in stupor and two generalized tonic–clonic seizures. MRI showed widespread, yet markedly asymmetric changes consistent with PRES largely sparing the right MCA territory. After the MAP was decreased to 85–100 mmHg, she had no further seizures. 2 days later she was fully alert with mild left hemiparesis. PRES is a rare complication of hemodynamic augmentation that should be considered in the differential diagnosis of delayed neurological decline in patients with aneurysmal SAH-associated cerebral vasospasm. The markedly asymmetric distribution of PRES lesions with sparing of the territory affected by vasospasm supports the hypothesis that hyperperfusion underlies the pathophysiology of this disorder.
Databáze: OpenAIRE
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