Acta Neurochirurgica

, Volume 161, Issue 2, pp 217–224 | Cite as

Post-partum posterior reversible encephalopathy syndrome requiring decompressive craniectomy: case report and review of the literature

  • Gennadiy A. Katsevman
  • Ryan C. Turner
  • Cletus Cheyuo
  • Charles L. Rosen
  • Matthew S. SmithEmail author
Case Report - Neurosurgery and pregnancy
Part of the following topical collections:
  1. Neurosurgery and Pregnancy


Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis. Despite initial conservative therapy including anti-epileptic drugs, magnesium therapy, empiric antibiotics, and Trendelenburg positioning, the patient continued to deteriorate. Follow-up imaging was suggestive of PRES with signs of intracranial hypertension. The patient underwent a decompressive suboccipital craniectomy for refractory and severe PRES and later fully recovered. This case highlights the sometimes difficult diagnosis of PRES, possible association with pregnancy, eclampsia/preeclampsia and/or cerebrospinal fluid drainage, and the rare but life-saving need for decompression in severe cases.


Posterior reversible encephalopathy syndrome Craniectomy Eclampsia Epidural 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Patient consent

The patient has consented to the submission of the case report for submission to the journal.


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© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryWest Virginia UniversityMorgantownUSA
  2. 2.Department of Neurology and Neurosurgery, Robert C. Byrd Health Sciences CenterWest Virginia UniversityMorgantownUSA

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