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

Reena Shah, Agnieszka Kubisz-Pudelko, Jeremy Reid, Reena Shah, Agnieszka Kubisz-Pudelko, Jeremy Reid

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological syndrome characterized by various symptoms of neurological disease. It has commonly been reported in association with acute hypertension, pre-eclampsia, eclampsia, sepsis, and exposure to immunosuppressants. Here, we report on a normotensive woman who developed a severe frontal headache, visual disturbances, and hypertension 3 days after undergoing an emergency laparotomy for ischemic colitis during which she suffered an inadvertent dural puncture. Neuro-imaging revealed features consistent with PRES. The patient went on to make a good recovery, being discharged 21 days postoperatively, with only minor visual disturbances and memory problems. This case highlights the importance of awareness of PRES to all specialties. On reviewing the literature, we feel that PRES may be a potential differential diagnosis to post-procedural neurological symptoms in those patients undergoing routine procedures such as spinal anesthetics or lumbar punctures.

Keywords: PRES; lumbar puncture; neurological disease; spinal anesthetic.

Figures

Figure 1
Figure 1
Computed tomography scan of head.
Figure 2
Figure 2
Magnetic resonance imaging of head.

References

    1. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.
    1. Hauser RA, Lacey DM, Knight MR. Hypertensive encephalopathy: magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol. 1988;45(10):1078–1083.
    1. Schwaighofer BW, Hesselink JR, Healy ME. MR demonstration of reversible brain abnormalities in eclampsia. J Comput Assist Tomogr. 1989;13(2):310–312.
    1. Bartynski WS, Boardman JF, Zeigler ZR, et al. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 2006;27(10):2179–2190.
    1. Appignani BA, Bhadelia RA, Blacklow SC, et al. Neuroimaging findings in patients on immunosuppressive therapy: experience with tacrolimus toxicity. AJR Am J Roentgenol. 1996;166(3):683–688.
    1. Legriel S, Pico F, Azoulay E. Understanding posterior reversible encephalopathy syndrome. Annu Update Intensive Care Emerg Med. 2011;1:631–653.
    1. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic oedema. AJNR Am J Neuroradiol. 2008;29:1043–1049.
    1. Neill TA, Hemphill JC. Reversible posterior leukoencephalopathy syndrome. 2013. [Accessed December 11, 2013]. Available from: .
    1. Mak A, Chan BP, Yeh IB, et al. Neuropsychiatric lupus and reversible posterior leucoencephalopathy syndrome: a challenging clinical dilemma. Rheumatology (Oxford) 2008;47:256–262.
    1. Alfery D, Marsh M, Shapiro H. Post-spinal headache or intracranial tumour after obstetric anesthesia. Anesthesiology. 1979;51:92–94.
    1. Susanto I. Hypertensive encephalopathy. 2013. [Accessed December 11, 2013]. Available from: .
    1. Rangi PS, Partridge WJ, Newlands ES, Waldman AD. Posterior reversible encephalopathy syndrome: a possible late interaction between cytotoxic agents and general anaesthesia. Neuroradiology. 2005;47:586–590.
    1. Ho CM, Chan KH. Posterior reversible encephalopathy syndrome with vasospasm in a postpartum woman after postdural puncture headache following spinal anaesthesia. Anesth Analg. 2007;105:770–772.
    1. Eran A, Barak M. Posterior reversible encephalopathy syndrome after combined general and spinal anaesthesia with intrathecal morphine. Anesth Analg. 2009;108(2):609–612.
    1. Minai F, Hasan S, Sheerani M. Post-dural puncture posterior reversible encephalopathy syndrome. J Coll Physicians Surg Pak. 2011;21:37–39.
    1. Yi J, Ha S, Kim Y, Choi E. Posterior reversible encephalopathy syndrome in an untreated hypertensive patient after spinal surgery under general anaesthesia. Korean J Anesthesiol. 2011;60(5):369–372.
    1. Vandam L, Dripps R. Long-term follow up of patients who received 10 098 spinal anaesthetics. JAMA. 1956;161:586–591.
    1. Grant R, Cordon B, Hart I, Teasdale G. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry. 1991;54:440–442.
    1. Hannerz J, Ericson K, Bro Skejo H. MR imaging with gadolinium in patients with and without post-lumbar puncture headache. Acta Radiol. 1999;40:135–141.
    1. Beausang-Linder M, Bill A. Cerebral circulation in acute arterial hypertension – protective effects of sympathetic nervous activity. Acta Physiol Scand. 1981;111:193–199.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner