Acute obstructive hydrocephalus in posterior reversible encephalopathy syndrome


  • J Hiesgen Department of Neurology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
  • T N Annor Department of Radiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa



PRES, Drugs


Posterior reversible encephalopathy syndrome (PRES) is an uncommon, subacute neurological disorder that presents radiologically with
a pattern of bilateral parieto-occipital areas of vasogenic oedema. Conditions commonly associated with PRES include autoimmune
disorders, cytotoxic drugs, metabolic abnormalities and, most frequently, hypertensive emergencies. Clinically, headache, visual
disturbances, seizures and an altered level of consciousness are often reported. The outcome is favourable if the underlying cause is
addressed. Posterior fossa involvement resulting in obstructive hydrocephalus is a rare presentation and may be misdiagnosed as a mass lesion or infection, leading to delayed or unnecessary treatment. We describe the clinical presentation, findings on neuroimaging and conservative management of a man with PRES resulting in severe cerebellar oedema and acute obstructive hydrocephalus. This case illustrates that awareness of atypical neuroimaging in PRES is important for the management of these patients and to avoid morbidity and mortality.


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How to Cite

Hiesgen J, Annor TN. Acute obstructive hydrocephalus in posterior reversible encephalopathy syndrome. S Afr Med J [Internet]. 2022 Dec. 20 [cited 2024 Jun. 15];113(1):9-12. Available from:

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