Posterior Reversible Encephalopathy Syndrome Arising from Simultaneous Cranioplasty and Ventriculoperitoneal Shunting: A Case Report.

Posterior reversible encephalopathy syndrome is a well-known condition that causes reversible vasogenic edema, mainly in the occipital lobe. However, no guideline for its diagnosis or treatment has been established to date. While many atypical cases have been reported in recent years, posterior reversible encephalopathy syndrome associated with cranioplasty has not yet been reported. A man in his 50s underwent right decompressive craniectomy for brain swelling secondary to ischemic stroke. He was transferred to another hospital for rehabilitation 9 months later and was again admitted for cranioplasty after 2 months. Because of sustained brain distension, right cranioplasty was performed simultaneously with ventriculoperitoneal shunting. No sudden change in blood pressure occurred during the perioperative period. However, generalized convulsions occurred postoperatively. Magnetic resonance imaging showed signal changes in the right frontal lobe, left basal ganglia, left thalamus, and right occipital lobe. When cranioplasty was performed simultaneously with ventriculoperitoneal shunting for a skull defect complicated by brain distension, intraoperative cerebrospinal fluid drainage and continuous cerebrospinal fluid drainage by shunts may have caused a sudden decrease in intracranial pressure and an increase in cerebral perfusion pressure, possibly leading to the development of posterior reversible encephalopathy syndrome.