A Case Report on Cerebral Autoregulation in Posterior Reversible Encephalopathy Syndrome after Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: Disturbed cerebral autoregulation remains a theoretical contributor to posterior reversible encephalopathy syndrome (PRES), but it has not been captured before. We report invasively measured autoregulation indices in a 50-year-old female with aneurysmal subarachnoid hemorrhage. CASE SUMMARY: PRES developed after induced hypertension and intra-arterial nimodipine infusion as treatment for delayed cerebral ischemia. The poorest autoregulation values were observed a week before PRES, at the time of delayed cerebral ischemia and sepsis. A second, less pronounced deterioration of autoregulation occurred before PRES diagnosis. Relevant comorbidities potentially related to PRES were fetal-type arterial supply to the posterior circulation, pneumonia, and steroid application. CONCLUSIONS: This is the first reported case with cerebral autoregulation measurements during PRES. Hypothetically, autoregulation could have contributed to PRES in a setting of persistent hypertension, immunological factors, and a more susceptible posterior circulation. Further data are required to reliably investigate the relationship between autoregulation and PRES.