Intracranial hypotension and PRES: case report.
We report a case of a woman presenting, 7 days after epidural analgesia for a caesarean section, to the emergency room for a worsening of the headache and tonico-clonic seizures. MRI showed alterations suggestive of the presence of intracranial hypotension (IH) as well as evidence of posterior reversible encephalopathy syndrome (PRES). She was treated with a blood patch which leads to the prompt regression of the clinical symptoms and follow-up MRI, after 15 days, showed complete resolution of radiological alterations. The possible pathogenetic relationship between IH, secondary to the inadvertent dural puncture, and PRES is discussed. We suggest that venous stagnation and hydrostatic edema, secondary to intracranial hypotension, probably played a crucial role in the pathogenesis of PRES.
Department of Neuroradiology, University of Rome La Sapienza, Rome, Italy. silviapugliese@gmail.com
Silvia
S
Pugliese
V
V
Finocchi
M L
ML
Borgia
C
C
Nania
B
B
Della Vella
A
A
Pierallini
A
A
Bozzao
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D001927:Brain Diseases / Q000150:complications* / Q000188:drug therapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006261:Headache / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D019585:Intracranial Hypotension / Q000209:etiology*; D008279:Magnetic Resonance Imaging
D000700:Analgesics