title: Posterior Reversible Encephalopathy Syndrome Secondary to CSF Leak and Intracranial Hypotension: A Case Report and Literature Review.
abstract: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical neuroradiological condition characterized by insidious onset of neurological symptoms associated with radiological findings indicating posterior leukoencephalopathy. PRES secondary to cerebrospinal fluid (CSF) leak leading to intracranial hypotension is not well recognized etiology of this condition. Herein, we report a case of PRES that occurred in the setting of CSF leak due to inadvertent dural puncture. Patient underwent suturing of the dural defect. Subsequently, his symptoms resolved and a repeated brain MRI showed resolution of brain lesions. The pathophysiology and mechanistic model for developing PRES in the setting of intracranial hypotension were discussed. We further highlighted the importance of tight blood pressure control in patients with CSF leak and suspected intracranial hypotension because they are more vulnerable to develop PRES with normal or slightly elevated bleed pressure values.
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Hammad
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: DeDent
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Algahtani
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Alastal
authors.affiliation: Department of Neurology, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Elmer
authors.affiliation: Department of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Azedine
authors.initials: A
authors.lastname: Medhkour
authors.affiliation: Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Safi
authors.affiliation: Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA.
authors.forename: Ragheb
authors.initials: R
authors.lastname: Assaly