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Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation

BACKGROUND: The authors describe a unique case of a patient who developed posterior reversible encephalopathy syndrome (PRES) following postoperative treatment of a Chiari I malformation. CASE DECSRIPTION: A 25-year-old female presented with complaints of left upper and lower extremity paresthesias...

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Autores principales: Hansberry, David R., Agarwal, Nitin, Tomei, Krystal L., Goldstein, Ira M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3814995/
https://www.ncbi.nlm.nih.gov/pubmed/24232171
http://dx.doi.org/10.4103/2152-7806.119076
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author Hansberry, David R.
Agarwal, Nitin
Tomei, Krystal L.
Goldstein, Ira M.
author_facet Hansberry, David R.
Agarwal, Nitin
Tomei, Krystal L.
Goldstein, Ira M.
author_sort Hansberry, David R.
collection PubMed
description BACKGROUND: The authors describe a unique case of a patient who developed posterior reversible encephalopathy syndrome (PRES) following postoperative treatment of a Chiari I malformation. CASE DECSRIPTION: A 25-year-old female presented with complaints of left upper and lower extremity paresthesias and gait disturbances. A magnetic resonance imaging (MRI) of the brain and cervical spine showed a Chiari I malformation with tonsillar descent beyond the level of the C1 lamina. She underwent a suboccipital craniectomy and C1 laminectomy with cerebellar tonsillar cauterization and duraplasty. Postoperatively, an MRI showed bilateral acute infarcts of the cerebellar vermis. She was initially treated for cerebellar ischemia with hypertensive therapy with a subsequent decline in her neurologic status and generalized tonic–clonic seizure. Further workup showed evidence of PRES. After weaning pressors, the patient had a significant progressive improvement in her mental status. CONCLUSION: Although the mechanism of PRES remains controversial given its diverse clinical presentation, several theories implicate hypertension and steroid use as causative agents.
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spelling pubmed-38149952013-11-14 Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation Hansberry, David R. Agarwal, Nitin Tomei, Krystal L. Goldstein, Ira M. Surg Neurol Int Case Report BACKGROUND: The authors describe a unique case of a patient who developed posterior reversible encephalopathy syndrome (PRES) following postoperative treatment of a Chiari I malformation. CASE DECSRIPTION: A 25-year-old female presented with complaints of left upper and lower extremity paresthesias and gait disturbances. A magnetic resonance imaging (MRI) of the brain and cervical spine showed a Chiari I malformation with tonsillar descent beyond the level of the C1 lamina. She underwent a suboccipital craniectomy and C1 laminectomy with cerebellar tonsillar cauterization and duraplasty. Postoperatively, an MRI showed bilateral acute infarcts of the cerebellar vermis. She was initially treated for cerebellar ischemia with hypertensive therapy with a subsequent decline in her neurologic status and generalized tonic–clonic seizure. Further workup showed evidence of PRES. After weaning pressors, the patient had a significant progressive improvement in her mental status. CONCLUSION: Although the mechanism of PRES remains controversial given its diverse clinical presentation, several theories implicate hypertension and steroid use as causative agents. Medknow Publications & Media Pvt Ltd 2013-09-30 /pmc/articles/PMC3814995/ /pubmed/24232171 http://dx.doi.org/10.4103/2152-7806.119076 Text en Copyright: © 2013 Hansberry DR http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Case Report
Hansberry, David R.
Agarwal, Nitin
Tomei, Krystal L.
Goldstein, Ira M.
Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation
title Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation
title_full Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation
title_fullStr Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation
title_full_unstemmed Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation
title_short Posterior reversible encephalopathy syndrome in a patient with a Chiari I malformation
title_sort posterior reversible encephalopathy syndrome in a patient with a chiari i malformation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3814995/
https://www.ncbi.nlm.nih.gov/pubmed/24232171
http://dx.doi.org/10.4103/2152-7806.119076
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