A rare case of posterior reversible encephalopathy syndrome following posterior fossa ependymoma resection a surgical case report

Abstract

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a rare complication following surgical intervention, with varied neurological manifestations. The inherent pathophysiology is diverse and risk factors include certain medical co-morbidities.

Presentation of case

A previously well 24-year-old female, presented with signs of elevated intracranial pressure, with further investigations highlighting a posterior fossa tumor. She was scheduled for resection of this intracranial lesion and the surgical procedure was uneventful. However, moderate but significant labile increases in blood pressures were noted intra- and post- operatively. Following surgery, a clinical presentation of limb weakness and gaze deviation was observed, leading to investigative imaging demonstrating PRES. She was treated expeditiously by a multi-disciplinary team. There was complete resolution of her symptomology once the underlying cause was identified.

Discussion

PRES is not a typical complication of a neurosurgical patient. Moreso, in a young patient without any medical comorbidities. Deviation of her blood pressures from the normal lead to the formation of vasogenic edema along the cerebral hemispheres. The manifestation of this clinically made it arduous to pinpoint a definitive diagnosis. With the aid of different specialists, a diagnosis was clenched, and treatment was successfully implemented.

Conclusion

The major learning point of this case history is the recognition of alterations from a patient's baseline vital signs (blood pressure) during and following surgical procedures. Additionally, the resultant consequences of these deviations, which may manifest as rare neurological conditions, such as PRES. The importance of a multi-disciplinary team in the management of this case was paramount.