• Neurosurgery · Jul 2018

    Case Reports

    Posterior Reversible Encephalopathic Syndrome in the Setting of Induced Elevated Mean Arterial Pressure in Patients With Spinal Cord Injury.

    • Alexander C Whiting, Manuel P Fanarjian, Randall J Hlubek, Jakub Godzik, U Kumar Kakarla, and Nicholas Theodore.
    • Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
    • Neurosurgery. 2018 Jul 1; 83 (1): 16-21.

    Background And ImportanceAcute spinal cord injury (SCI) is managed by avoiding hypotension and elevating mean arterial pressure (MAP) to attain optimal perfusion of the spinal cord. Few studies have been published regarding complications related to this treatment paradigm.Clinical PresentationThree patients with SCI developed posterior reversible encephalopathic syndrome (PRES) during treatment with intravenous fluids and vasopressors administered to maintain elevated MAPs. All of them experienced temporary elevations well above the standard blood pressure goals for acute SCI and deterioration of neurological status.ConclusionPRES is a potential complication of elevated MAPs in patients with SCI, particularly if the blood pressure rises above the goals of standard treatment paradigms. The neurosurgical staff should be suspicious of possible PRES early in the course of acute SCI in patients with unexplained neurological decline. This case series is the first report of PRES in patients with acute SCI.

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