Abstract:
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.
