Posterior Reversible Encephalopathy Syndrome Causing Transient Postoperative Blindness Following Spine Surgery

Arasu, Meenupriya; Kannamani, Balaji; Elakkumanan, Lenin Babu

doi:10.1055/s-0041-1731919

Cited by 3 publications

(8 citation statements)

References 7 publications

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“…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%).…”

Section: Discussionmentioning

confidence: 99%

“…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] .…”

Section: Discussionmentioning

confidence: 99%

“…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] . Second, PRES was related to early-onset after surgery (ie, from 30 minutes to 24 hours after surgery) [ 3 , 6 , [9] , [10] , [11] , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, PRES was related to early-onset after surgery (ie, from 30 minutes to 24 hours after surgery) [ 3 , 6 , [9] , [10] , [11] , 13 ]. Possible surgery-related mechanisms include decompressed peripheral blood vessels, sympathetic dysreflexia due to dorsal cord injury/compression, cerebrospinal fluid leakage, general anesthetic agents, and hypertension due to postoperative pain [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , all of which may involve collapsed circulatory regulation and an associated loss of cerebral autoregulation. Third, PRES was related to visual loss, seizure, hypertension, disorientation, and headache in the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Matsuo

Morimoto

Kobayashi

et al. 2023

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Matsuo

Morimoto

Kobayashi

et al. 2023

Radiology Case Reports

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Acute perioperative neurological emergencies

Lam

Luoma

Reddy

2023

International Anesthesiology Clinics

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Perioperative neurological complications can be a result of anesthesia or surgical procedures. Both surgery and anesthesia increases the risk of neurological sequelae due to ischemia, hemorrhage, hypoxia, or metabolic disorder (Table 1). [1][2][3][4][5][6][7][8][9][10] The impact can be devastating, leading to morbidity, increased length of stay, impaired quality of life, and mortality. [11][12][13] During anesthesia, there is no standard monitoring for the neurological system compared with other organs (eg, electrocardiograph and blood pressure for the cardiovascular system, pulse oximetry, and capnography for the respiratory system). When patients present with neurological signs and symptoms perioperatively, early assessment and imaging is needed to facilitate prompt diagnosis and management.This article will provide an overview of common neurological complications in the perioperative period. To cover details of all neurological emergencies will be beyond the scope of this article. We will focus on common emergencies in general surgery with a brief discussion of neurological complications in specific surgical populations. The common presentation of these complications will be explored, followed by the diagnosis and management of these pathologies. Presentation of neurological emergencies Focal neurological deficitNeurological deficit can be caused by injury to the brain, spinal cord, or peripheral nerves. Careful neurological examination and interpretation with clinical context is needed to identify the possible site of injury and arrive at the correct diagnosis. Common causes of neurological deficit with corresponding physical findings is summarized in Table 2.

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Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis

Morimoto,

Kobayashi,

Hirata

et al. 2024

Spine Surg Relat Res

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Introduction Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during spine surgery were assessed through a retrospective descriptive study and meta-analysis. Methods Patients aged ≥18 years who underwent spine surgery under general anesthesia at a hospital between April 2011 and March 2023 were examined. Of the 2,391 initially identified patients, 2,346 were included after excluding 45 who underwent debridement for surgical site infections. Subsequently, a meta-analysis including the present retrospective descriptive study was conducted. Databases such as PubMed and Google Scholar were searched for original peer-reviewed articles written in English. Results Of the 2,346 patients, 4 (0.17%) (three men, one woman) exhibited perioperative CVAs associated with spine surgery. The CVAs were diverse in nature: one case of cerebral hemorrhage resulting from dural injury during posterior occipitocervical fusion, two cases of cerebral infarctions after lumbar laminectomy and anterior thoracic fusion due to anticoagulant discontinuation, and one case of posterior reversible encephalopathy syndrome following microscopic lumbar discectomy due to gestational hypertension. The subsequent meta-analysis included three studies (n=186,860). It showed several risk factors for perioperative CVAs, including cervical level (pooled odds ratio [OR]=1.33), hypertension (pooled OR=2.27), atrial fibrillation (pooled OR=8.78), history of heart disease (pooled OR=2.47), and diabetes (pooled OR=2.13). Conclusions It was speculated that the potential risk factors for the four perioperative CVA cases of spine surgery in this retrospective descriptive study were intraoperative dural injury, preoperative anticoagulant discontinuation, and gestational hypertension history. The meta-analysis revealed that cervical spine surgery, hypertension, atrial fibrillation, heart disease, and diabetes increased the CVA risk. This highlights the need for risk assessment, preoperative optimization, and postoperative care to reduce spine surgery-associated perioperative CVAs.

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Posterior Reversible Encephalopathy Syndrome Causing Transient Postoperative Blindness Following Spine Surgery

Cited by 3 publications

References 7 publications

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

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

Acute perioperative neurological emergencies

Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis

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