Posterior reversible encephalopathy syndrome in an untreated hypertensive patient after spinal surgery under general anesthesia -A case report-

Abstract

Posterior reversible encephalopathy syndrome (PRES) is an unfamiliar term to anesthesiologists, and this is characterized by neurologic symptoms that include mental change, headache, seizure and visual disturbance and also abnormal neuroimaging finding. A 71-year-old female patient was operated on for posterior decompression and total laminectomy under general anesthesia for the spinal stenosis. After the operation, she developed generalized tonic-clonic seizure and a stuporous mentality in the recovery room. The magnetic resonance imaging (MRI) revealed swelling and increased signal intensity at the deep gray nuclei, cerebral cortex and cerebellum. After one week, she returned to an alert mentality and then she was diagnosed with PRES. She was discharged without any neurologic deficit on postoperative day 20. This report describes our experience with PRES after spinal surgery was performed under general anesthesia on a suspected untreated hypertensive patient.

Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis – a case report

“…The occurrence of PRES following epidural or spinal anesthetic has been described before in patients with uncontrolled preoperative hypertension, parturient patients, or those who have received chemotherapy 12–16. Could PRES have been attributed to the dural puncture, and should it be considered as a differential diagnosis of post-dural puncture headache?…”

Perioperative visual loss after spine surgery

“…It is associated with acute medical illnesses such hypertensive episodes, autoimmune disease, malignancy, chemotherapy, immunosuppressant therapy, infection, renal disease, vasculitis, eclampsia, and preeclampsia [38] . Although more closely identified with obstetric patients, PRES has also been reported after lumbar fusion [39] , hysterectomy [40] and video-assisted-thoracoscopic wedge resection [41] . PRES has characteristic MRI findings.…”

Perioperative posterior reversible encephalopathy syndrome in a patient with no history of hypertension: a case report

“…Alterations in hemodynamic state can lead to PRES. Several reports on PRES associated with general anesthesia have been published [ 3 – 7 ]. Although there are various causes for this syndrome, affected patients typically have hypertension at the time of presentation or a history of hypertension.…”

“…A group of diseases with similar clinical courses and neuro-radiological findings, PRES is characterized by headache, altered mental functioning, seizures, loss of vision, and, typically, hypertension [ 1 , 2 ]. Reports of PRES have been published increasingly frequently in recent years; however, there are few reports of PRES associated with general anesthesia [ 3 – 7 ], the syndrome having various causes.…”