case_images: PMC11786757_01
case_images: Preoperative MRI: axial T1weighted image post contrast and coronal FLAIR weighted image showing the tumor in the cerebellopontine angle.
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case_images: A 52-year-old woman presented to our department for surgical treatment of a large VS (Koos grade 4) on the right side (Fig. 1).
case_images: Non enhanced cranial computed tomography post resection showing subtle hypodensity of both occipital poles (marked with asterisks) as a first sign of PRES.
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case_images: After the symptoms continued to worsen, another CT scan performed in the morning of the following day and ruled out intracranial hemorrhage or air insufflation but showed subtle hypodensity of both occipital poles as a first sign of PRES (Fig. 2).
case_images: Follow up CCT 24h later - significant hemorrhage at the site of both occipital poles with a larger hematoma at the right hand side.
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case_images: Repeated CT demonstrated a slightly progressive right parieto-occipital diffuse cerebral swelling, a right-sided intracerebral hematoma and a subdural hematoma with bilateral components of subarachnoid hemorrhage (Fig. 3).
case_images: Follow up MRI (three subsequent FLAIR weighted images from cranial to caudal with a corresponding T2* section in the upper left corner of the middle image) again 24h later showing both, significant white matter hyperintensity reflecting vasogenic edema and subacute hematoma.
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case_images: A cranial MRI performed on the fifth postoperative day showed diffuse subcortical T2 signal enhancement also in the area of the border zones frontal to parietal bilaterally, which further supported the diagnosis of PRES (Fig. 4).
case_images: Follow up MRI (T1 Vibe post contrast axial reconstruction, coronal FLAIR, axial T2w section, from left to right) two months after resection of the tumor showing complete resolution of the acute PRES with hemosiderin residues visible at the right hand side occipital pole in the T2w image.
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case_images: A follow-up MRI two months after the event showed complete regression of the PRES syndrome with residual haemosiderin in the area of the hemorrhage (Fig. 5).
case_images: Timeline of the case report.
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case_images: A timeline of this case report can be seen in Fig. 6.