Reply to Dr. Takeuchi: PRES after epidural anesthesia

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Author Information

Author(s): Silvia Pugliese, Alessandro Bozzao

Primary Institution: Department of Neuroradiology, University of Rome La Sapienza

The association between intracranial hypotension (IH) and posterior reversible encephalopathy syndrome (PRES) is presumed to be causal.

The study suggests that intracranial hypotension following epidural anesthesia was likely the leading cause of PRES in the patient.

Normal MRA findings ruled out RCVS in the patient.
The headache was different from the typical thunderclap headache associated with RCVS.
MR findings were typical of PRES, indicating a possible link to IH.

The doctors think that a headache after an epidural might be caused by low pressure in the brain, not by another condition called RCVS.

The authors acknowledge limitations in their single case experience and the evidence provided.

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