Surgical treatment of severe Posterior Reversible Encephalopathy Syndrome (PRES) with brainstem involvement: Systematic Review and Illustrative Case

Background: and Purpose – Untreated hypertension can lead to severe posterior reversible encephalopathy syndrome (PRES), that is a reversible intracranial complication. Involvement of posterior fossa structures including brainstem is extremely rare but life-threatening condition if not treated properly and timely. Here we review different clinical aspects of surgically treated cases of PRES with brainstem involvement and present an illustrative case. Methods: – We searched the MEDLINE electronic database for studies on PRES with brainstem involvement. Hypertensive crisis as a cause of PRES and surgical treatment of PRES were inclusion criteria. We show a successfully treated case with this constellation. Finally, we summarize the data in current literature to provide treatment recommendation for this rare devastating condition. Results: – We found 5 reports with a total of 7 patients of PRES with brainstem involvement which were treated by posterior fossa decompression. Hypertension or malignant hypertension were common at onset of PRES. 85% of all cases were females and one of these cases was a 3-year-old girl. 71% of patients had a mRS ≤ 3 at discharge. Conclusions: – A clinically manifest brainstem PRES can be alleviated successfully through posterior fossa decompression so the ischemic and oedematous brain tissue can regenerate without further injury due to mechanical compression.