Reversible postoperative blindness caused by bilateral status epilepticus amauroticus following thoracolumbar deformity correction: case report

Abstract

<jats:p>Postoperative vision loss (POVL) is a devastating complication and has been reported after complex spine procedures. Anterior ischemic optic neuropathy and posterior optic neuropathy are the 2 most common causes of POVL. Bilateral occipital lobe seizures causing complete blindness are rare and have not been reported as a cause of POVL after spine surgery with the patient prone. The authors report the case of a 67-year-old man without a history of seizures who underwent a staged thoracolumbar deformity correction and developed POVL 6 hours after surgery. Imaging, laboratory, and ophthalmological examination results were nonrevealing. Routine electroencephalography study results were negative, but continuous electroencephalography captured bilateral occipital lobe seizures. The patient developed nonconvulsive status epilepticus despite initial treatment with benzodiazepines and loading doses of levetiracetam and lacosamide. He was therefore intubated for status epilepticus amauroticus and received a midazolam infusion. After electrographic seizure cessation for 48 hours, the patient was weaned off midazolam. The patient was maintained on levetiracetam and lacosamide without seizure recurrence and returned to his preoperative visual baseline status.</jats:p>

Posterior reversible encephalopathy syndrome following spine surgery: A case report and review of the literature

“…A total of 12 cases (male, n = 2; female, n = 10; average age, 59.5 years [range, 14-82 years]) of PRES following spine surgery were identified in 11 articles [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . Regarding comorbidities, many of the patients had hypertension (58.3%).…”

“…We found some common clinical characteristics between our report and previous reports. First, PRES was related to pregnancy-induced hypertension [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , 12 , 13 ] and/or a medical history of hypertension [ [3] , [4] , [5] , [6] , [7] , [9] , [10] , [11] ]. These clinical characteristics may be related to post-operative collapse of circulatory regulation, leading to PRES [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] .…”

“…PRES is completely curable after prompt symptomatic treatment (eg, antihypertension) in most cases; otherwise, it could result in permanent neurologic deficits or death. In contrast, PRES following spine surgery was first documented in 2011 [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . Reports on this condition have been rare, and sufficient consensus has not been established for clinical application.…”

Levetiracetam in der Behandlung des Status epilepticus – ein update

“…Bemerkenswert ist, dass ausbleibende Behandlungserfolge überwiegend in ganz bestimmten klinischen Situationen berichtet werden (z. B. postanoxisch [26,40], SCN1A Mutation [29], cerebrale Fett-Embolie [31], Katzenkratzkrankheit [32], Paclitaxel-Exposition [33], Sinusvenenthrombose [34], Alpha-Liponsäure-Intoxikation [35], Absence-Status epilepticus [38], Steroidresponsive Enzephalophathie (SREAT) [40,44], SCN2A Mutation und ausgeprägte corticale Dysplasie [41], postoperativer SE amauroticus [43], Methaldehyd-Intoxikation [45]. Lediglich [22] in ihren Studien, anders als in den anderen Arbeiten, ein sehr frühes Zeitfenster und aufgrund der Pharmakokinetik des Levetiracetams vermutlich Spontanverläufe, was auch durch den Vergleich mit der Placebogruppe in der Studie von Navarro und Mitarbeitern belegt ist [21].…”

Altered white matter integrity in patients with monocular blindness: A diffusion tensor imaging and tract‐based spatial statistics study

“…(Sun et al, 2019) In addition, ocular trauma and brain neuropathy may lead to blindness. (Ibrahim, Sweis, & Nockels, 2017;Koki et al, 2018) Drug and surgical treatments exert beneficial effects on reversible blindness, and recent studies have shown that treatment of irreversible blindness may be possible. (Chen et al, 2019;Shim et al, 2019) Blindness has become a global health problem, with a total of 145.2 million individuals worldwide suffering from severe vision impairment or blindness due to preventable and remediable reasons.…”