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Case Reports in Neurological Medicine
Volume 2015, Article ID 538523, 5 pages
http://dx.doi.org/10.1155/2015/538523
Case Report

Posterior Reversible Encephalopathy Syndrome Secondary to CSF Leak and Intracranial Hypotension: A Case Report and Literature Review

1Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA
2Department of Neurology, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA
3Department of Neurosurgery, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA
4Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA

Received 9 April 2015; Accepted 18 May 2015

Academic Editor: Isabella Laura Simone

Copyright © 2015 Tariq Hammad et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical neuroradiological condition characterized by insidious onset of neurological symptoms associated with radiological findings indicating posterior leukoencephalopathy. PRES secondary to cerebrospinal fluid (CSF) leak leading to intracranial hypotension is not well recognized etiology of this condition. Herein, we report a case of PRES that occurred in the setting of CSF leak due to inadvertent dural puncture. Patient underwent suturing of the dural defect. Subsequently, his symptoms resolved and a repeated brain MRI showed resolution of brain lesions. The pathophysiology and mechanistic model for developing PRES in the setting of intracranial hypotension were discussed. We further highlighted the importance of tight blood pressure control in patients with CSF leak and suspected intracranial hypotension because they are more vulnerable to develop PRES with normal or slightly elevated bleed pressure values.