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A case of posterior reversible encephalopathy syndrome after emergence from anesthesia.

Abstract
Posterior reversible encephalopathy syndrome (PRES) is a relatively new clinical entity characterized by reversible neurological symptoms with findings indicating leukoencephalopathy on imaging studies. Reports of PRES in the field of anesthesiology have been quite limited. A patient with therapeutic anticoagulant developed PRES immediately after emergence from anesthesia, in which her status was initially recognized as delayed recovery from anesthesia with transient hypertension because an emergent head computed tomography (CT) scan was almost normal. Subsequently, magnetic resonance imaging (MRI) was also performed according to a radiologist's recommendation because the CT results showed areas of slightly low attenuation in the frontoparieto-occipital lobes bilaterally, suggesting PRES; otherwise, ischemic events. MRI showed subcortical increased T(2) and fluid-attenuated inversion recovery (FLAIR) intensity in the occipitoparietal regions bilaterally with slight increase in the apparent diffusion coefficient signal on diffusion-weighted imaging, which confirmed a diagnosis of PRES. Gradually, the patient regained consciousness and became responsive with antihypertensive therapy. A prompt and accurate diagnosis of PRES is important to avoid irreversible brain damage, for example, intracranial hemorrhage, especially in a patient receiving anticoagulation therapy.
AuthorsSatoki Inoue, Masahiko Kawaguchi, Hitoshi Furuya
JournalJournal of anesthesia (J Anesth) Vol. 26 Issue 1 Pg. 111-4 (Feb 2012) ISSN: 1438-8359 [Electronic] Japan
PMID22012172 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anesthetics
Topics
  • Aged
  • Anesthetics (adverse effects)
  • Cerebrovascular Circulation
  • Female
  • Humans
  • Hypercapnia (complications)
  • Hypertension (complications)
  • Posterior Leukoencephalopathy Syndrome (etiology)

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