Posterior Reversible Encephalopathy Syndrome associated with Subarachnoid Hemorrhage : A Case Report

Abstract

  We report a case of posterior reversible encephalopathy syndrome (PRES) during the subacute period of subarachnoid hemorrhage (SAH). An 84-year-old female with a ruptured basilar top aneurysm underwent successful embolization. Administration of antihypertensive drugs was discontinued to avoid hypotension during the period of vasospasm. On day 17 post embolization, her consciousness level deteriorated, and her MRI showed vasogenic edema in the bilateral occipital lobes. Under the diagnosis of PRES, antihypertensive therapy was resumed, and her symptoms and MRI findings improved.
  Thirteen cases of PRES after SAH have been reported, and it has been suggested that endothelial cell dysfunction due to primary brain damage due to SAH and hypertension during the period of vasospasm induces PRES. Though the occurrence of PRES after SAH is rare, neurosurgeons should be aware of this potential complication during the subacute period of SAH, because complete resolution of this syndrome is attainable with appropriate blood pressure control.