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Background and Aims Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by neurological symptoms and white matter edema on neuroimaging studies. While many etiologies and risk factors have been described, its pathophysiology remains unclear.

Methods A 50-year-old woman was admitted with an abnormal vaginal bleeding due to a large uterine fibroid causing severe anemia (Hemoglobin: 2g/dL). She was otherwise healthy. Over the next ten days, she received a total of five packed red blood cell units. Twelve days after admission, she was submitted to an uneventful hysterectomy under general anesthesia and epidural analgesia. Postoperative analgesia was maintained with ropivacaine 0,1% through an epidural drug infusion balloon at 5cc/h which was removed 48 hours after the procedure. Three days after surgery, she developed headaches and vomiting followed by altered mental status, focal neurological deficits and seizures. She was treated with antiepileptic medication, supportive care and transferred to an ICU. Neuroimaging ruled out a stroke and revealed typical findings of PRES. Within a week the neurological deficits fully reversed and the patient was discharged from the hospital.

Results Although it is associated with hypertension, PRES is also linked to polytransfusion and.

Conclusions A wide array of etiologies and risk factors are associated with PRES and a literature review is required to better understand this syndrome in the perioperative period, including its relationship with central nerve blocks.