01-05-2016 | Case Report
Posterior reversible encephalopathy syndrome (PRES): a rare condition after resection of posterior fossa tumors: two new cases and review of the literature
Published in: Child's Nervous System | Issue 5/2016
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Introduction
In 1996, Hinchey and colleagues coined the term “Posterior reversible encephalopathy syndrome” (PRES) to describe a condition seen in patients with acute neurological symptoms and reversible subcortical vasogenic edema predominantly involving parieto-occipital areas demonstrated in brain MRI. The occurrence of this phenomenon after surgical resection of CNS tumors is typically linked to pediatric cases.
Material and Methods
Two new cases of PRES after posterior fossa surgery are reported. A thorough review of the literature is carried out with the purpose of updating and summarizing the main features regarding PRES in similar cases. Seven cases ofPRES after resection of a posterior fossa tumor have been hitherto reported (4 patients were <20 years old). Thereis another pediatric case described after a ventriculoperitoneal shunting procedure in a patient with fourth ventricleependymoma. Two resected tumors were ependymomas, 2 hemangiopericytomas in one patient, 1 pilocyticastrocytoma, 1 vestibular schwannoma, and 1 of the reported cases did not describe the final pathology diagnosis.
Case Reports
We present 2 new cases of PRES after surgical resection of a posterior fossa tumor (medulloblastoma in case 1and ependymoma in case 2) in pediatric patients. Case 1 developed delayed seizures and altered mental status(10 days after surgical resection) after receiving treatment with bromocriptine for cerebellar mutism. Case 2presented with generalized seizures and altered mental status within the first 48 postoperative hours followed byright hemiparesis. Both patients fully recovered and returned to neurological baseline status. A thorough review ofthe literature was carried out with the purpose of updating and summarizing the main features regarding PRES insimilar cases.
Conclusions
We report 2 new pediatric cases of posterior reversible encephalopathy syndrome (PRES) that developed after surgical resection of a posterior fossa tumor. Appropriate management includes supportive measures, antihypertensive agents, and antiepileptic drugs, if needed. Full recovery is the most likely outcome in line with previous articles.