Posterior reversible enzephalopathie syndrome (PRES) following vestibular schwannoma surgery – Case report and review of the current theories on pathophysiology of PRES

Introduction

Posterior reversible encephalopathy syndrome (PRES) is an acute form of encephalopathy. Main characteristic of this syndrome is the development of subcortical/cortical edema in the occipital lobes. The most common causes are diseases such as pre-eclampsia, autoimmune diseases, allogeneic stem cell transplantation and after treatment with immunosuppressants or cytostatics. However, PRES is also occasionally observed in connection with neurosurgical procedures, particularly in the posterior fossa in pediatric patients.

Research question

PRES in adults is extremely rare. After cranial surgery, the impaired consciousness caused by this syndrome may be misdiagnosed.

Material and methods

We present a rare case of PRES associated with vestibular schwannoma (VS) surgery and metronidazole use and have conducted a literature review.

Results

We found only two cases of PRES after surgery of a VS in the literature and three cases in connection with the administration of metronidazole. All cases involved women but the onset of symptoms was highly variable. The constellation of surgery and administration of metronidazole has not yet been described.

Discussion and conclusion

The purpose of this review is to raise awareness of a very rare complication such as PRES in this setting. Antibiotics should be chosen carefully after such an operation, as this syndrome can be triggered by certain substances.