Hwang J, Cho WH, Cha SH, Ko JK. Posterior reversible encephalopathy syndrome following uneventful clipping of an unruptured intracranial aneurysm: A case report. World J Clin Cases 2023; 11(19): 4723-4728 [PMID: 37469736 DOI: 10.12998/wjcc.v11.i19.4723]
Corresponding Author of This Article
Jun-Kyueng Ko, MD, PhD, Associate Professor, Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 49241, South Korea. redcheek09@naver.com
Research Domain of This Article
Neuroimaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 6, 2023; 11(19): 4723-4728 Published online Jul 6, 2023. doi: 10.12998/wjcc.v11.i19.4723
Posterior reversible encephalopathy syndrome following uneventful clipping of an unruptured intracranial aneurysm: A case report
Joseph Hwang, Won-Ho Cho, Seung-Heon Cha, Jun-Kyueng Ko
Joseph Hwang, Won-Ho Cho, Seung-Heon Cha, Jun-Kyueng Ko, Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan 49241, South Korea
Author contributions: Ko JK and Hwang J contributed to manuscript writing and editing, and data collection; Cho WH and Cha SH contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported byClinical Research Grant from Pusan National University Hospital in 2022.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images. We guarantee patient anonymity.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Kyueng Ko, MD, PhD, Associate Professor, Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan 49241, South Korea. redcheek09@naver.com
Received: April 13, 2023 Peer-review started: April 13, 2023 First decision: May 8, 2023 Revised: May 10, 2023 Accepted: June 6, 2023 Article in press: June 6, 2023 Published online: July 6, 2023 Processing time: 78 Days and 3.4 Hours
Abstract
BACKGROUND
Posterior reversible encephalopathy syndrome (PRES) is characterized mainly by occipital and parietal lobe involvement, which can be reversible within a few days. Herein, we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm (UIA).
CASE SUMMARY
A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery. Clipping surgery was performed uneventfully, and he regained consciousness quickly immediately after the surgery. At the 4th hour after surgery, he developed a disorder of consciousness and aphasia. Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal, occipital, and frontal lobes ipsilaterally, without restricted diffusion, consistent with unilateral PRES. With conservative treatment, his symptoms and radiological findings almost completely disappeared within weeks. In our case, the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.
CONCLUSION
Our unique case highlights that, to our knowledge, this is the second report of PRES developing after craniotomy for the treatment of UIA. Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.
Core Tip: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by predominant parietal and occipital involvement, which can be reversible within a few days. We report a rare case of PRES that developed after clipping surgery for an unruptured intracranial aneurysm (UIA). In our case, the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion. Our unique case highlights that, to our knowledge, this is the second report of PRES developing after craniotomy for the treatment of UIA. Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.
