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Il Giornale Italiano di Radiologia Medica 2018 Gennaio-Febbraio;5(1):135-40

DOI: 10.23736/S2283-8376.17.00012-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: Italian

A case of PRES secondary to spinal shock and liquoral hypotension

Luca CASCHERA 1 , Bruno TUSCANO 1, Lorenzo PIERGALLINI 1, Domenico RICCI 1, Angelo LAZZARA 1, Mario POLIMENI 2, Angelo VANZULLI 3

1 Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italia; 2 Dipartimento di Neuroradiologia Diagnostica e Interventistica, ASST Grande Ospedale Metropolitano, Niguarda, Milano, Italia; 3 Dipartimento di Scienze Cliniche e Biomediche, Università degli Studi di Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milano, Italia


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Posterior reversible encephalopathy syndrome (PRES) is an acute onset clinical-radiological entity, characterized by reversible subcortical vasogenic cerebral edema and classic neurological symptoms emerging in a definite clinical scenario. At 20 years since the term PRES was coined this syndrome has yet several unknown characteristics. Although its causes are numerous and varied, four main pathophysiologic mechanisms are assumed, with the increasingly recognized role of liquoral hypotension. We present a case of PRES developed in a normotensive healthy young woman after inadvertent dural puncture for spinal anesthesia during a caesarian section with subsequent spinal shock and liquoral hypotension; it is emphasized the etiological role of liquoral hypotension and the need for a timely diagnosis transversal to multiple medical specialties, based on the recognition of signs and symptoms in the particular clinical context, to avoid permanent neurological sequelae.


KEY WORDS: Posterior leukoencephalopathy syndrome - Spinal puncture - Cesarean section - Cerebrospinal fluid

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