gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Posterior reversible encephalopathy syndrome as an over looked complication of induced hypertension for cerebral vasospasm: A systematic review and illustrative case

Meeting Abstract

  • Sajjad Muhammad - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • Ági Oszvald - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • Susanne Greschus - Klinik für Radiologie, Universitätsklinikum Bonn
  • Jasmin Scorzin - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • Erdem Güresir - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • Hartmut Vatter - Klinik für Neurochirurgie, Universitätsklinikum Bonn

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 167

doi: 10.3205/14dgnc561, urn:nbn:de:0183-14dgnc5612

Published: May 13, 2014

© 2014 Muhammad et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Delayed cerebral ischemia associated with cerebral vasospasm (CVS) is a common cause of secondary neurological decline after aneurysmal subarachnoid hemorrhage (SAH). Triple-H therapy including induced hypertension, hypervolemia, and hemodilution is often utilized to treat CVS. However, hypertensive treatment may carry significant medical morbidity, including cardiopulmonary, renal, as well as intracranial complications. Posterior reversible encephalopathy syndrome (PRES) is a reversible intracranial complication that has rarely been reported in the setting of induced hypertension.

Method: We present an illustrative case of PRES in a patient with induced hypertension for SAH related CVS and performed a systematic review. Furthermore, the electronic database MEDLINE was searched for additional data in published studies of PRES after induced hypertension.

Results: Overall, 7 case reports presenting 10 patients who developed PRES secondary to induced hypertension were found. 82% of the patients were female. In all cases the clinical symptoms were attributed to CVS before the diagnosis of PRES. The time from onset of induced hypertension to the development of PRES was 7.8 ± 3.8 days. After the diagnosis of PRES and careful taper down of the blood pressure, the neurological symptoms resolved almost completely within a few days in all patients.

Conclusions: PRES in the setting of SAH is an over looked complication of hypertensive therapy for the treatment of vasospasm. However, the diagnosis of this phenomenon is crucial given the necessity to reverse hypertensive therapy, which is contrary to the usual management of patients with vasospasm.