naa a22 4500 510799442 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9852-z doi (NATIONALLICENCE)springer-10.1007/s12028-013-9852-z Refractory Intracranial Hypertension in Posterior Reversible Encephalopathy Syndrome [Elektronische Daten] [Alberto Facchini, Sandra Magnoni, Vittorio Civelli, Fabio Triulzi, Mario Nosotti, Nino Stocchetti] Introduction: Posterior reversible encephalopathy syndrome (PRES) is a largely reversible disease with long-term favorable outcome. A minority of patients, however, may develop progressive cerebral edema and ischemia resulting in severe disability or death. We report a case of severe intracranial hypertension associated with PRES that was successfully treated according to intracranial pressure (ICP)- and cerebral perfusion pressure (CPP)-driven therapy. Methods: Case report. Results: A 42-year-old woman underwent bilateral lung transplantation for severe bronchiectasis. Her immunosuppressive regimen consisted of azathioprine, prednisone, and tacrolimus. She acutely developed an aggressive form of PRES that rapidly resulted in severe refractory intracranial hypertension despite discontinuation of potentially causative medications and adequate supportive therapy. Accordingly, second-tier therapies, including barbiturate infusion, were instituted and immunosuppression was switched to anti-thymocyte globulin followed by mycophenolate mofetil. Within 10h of barbiturate administration, ICP dropped to 20mmHg. Thiopental was administered for two days and then rapidly tapered because of severe urosepsis. Six months after discharge from the intensive care unit the patient returned to near-normal life, her only complaint being short-term amnesia. Conclusions: The decision to undertake ICP monitoring in medical conditions in which no clear recommendations exist greatly relies on physicians' judgment. This case suggests that ICP monitoring may be considered in the setting of acute PRES among selected patients, when severe intracranial hypertension is suspected, provided that a multidisciplinary team of neurocritical care specialists is readily available. Springer Science+Business Media New York, 2013 Reversible posterior leukoencephalopathy syndrome nationallicence Status epilepticus nationallicence Intracranial hypertension nationallicence Immunosuppressive agents nationallicence Barbiturate nationallicence Lung transplantation nationallicence Facchini Alberto Milan University, Milan, Italy aut Magnoni Sandra Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy aut Civelli Vittorio Unit of Neuroradiology, Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy aut Triulzi Fabio Unit of Neuroradiology, Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy aut Nosotti Mario Milan University, Milan, Italy aut Stocchetti Nino Milan University, Milan, Italy aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 376-380 1541-6933 19:3<376 2013 19 12028 https://doi.org/10.1007/s12028-013-9852-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9852-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Facchini Alberto Milan University, Milan, Italy aut NATIONALLICENCE 700 1- Magnoni Sandra Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy aut NATIONALLICENCE 700 1- Civelli Vittorio Unit of Neuroradiology, Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy aut NATIONALLICENCE 700 1- Triulzi Fabio Unit of Neuroradiology, Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy aut NATIONALLICENCE 700 1- Nosotti Mario Milan University, Milan, Italy aut NATIONALLICENCE 700 1- Stocchetti Nino Milan University, Milan, Italy aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 376-380 1541-6933 19:3<376 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer