Cargando…

Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement

INTRODUCTION: Induced hypertension, administered peri-operatively during thoraco-abdominal aortic intervention, is one of the most effective methods to maintain spinal cord perfusion pressure. Posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome is a rare enc...

Descripción completa

Detalles Bibliográficos
Autores principales: Yoshida, Soshi, Koizumi, Shigeki, Koyama, Tadaaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025093/
https://www.ncbi.nlm.nih.gov/pubmed/36949864
http://dx.doi.org/10.1016/j.ejvsvf.2023.02.001
_version_ 1784909251515252736
author Yoshida, Soshi
Koizumi, Shigeki
Koyama, Tadaaki
author_facet Yoshida, Soshi
Koizumi, Shigeki
Koyama, Tadaaki
author_sort Yoshida, Soshi
collection PubMed
description INTRODUCTION: Induced hypertension, administered peri-operatively during thoraco-abdominal aortic intervention, is one of the most effective methods to maintain spinal cord perfusion pressure. Posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome is a rare encephalopathy, possibly caused by excessive hypertension, usually encountered in the obstetric or cerebrovascular department. REPORT: A 61 year old man underwent open surgery for repair of an extent II dissecting thoraco-abdominal aneurysm. Several attempts at spinal drainage tube insertion one day prior to surgery failed. The Adamkiewicz artery was anastomosed by bypass, and transcranial motor evoked potentials were generally stable. Initially, no apparent neurological abnormality was observed after surgery; however, paraplegia occurred on post-operative day 1. The patient’s mean arterial pressure increased from > 85 mmHg to > 95 mmHg. His systolic blood pressure occasionally exceeded 170 mmHg. On post-operative day 3 he became blind. A serial imaging test revealed cerebral oedema of both posterior lobes and segmental constriction of the vertebral and basilar arteries. Posterior reversible encephalopathy syndrome with reversible cerebral vasoconstriction syndrome was diagnosed from the clinical context and imaging tests. Despite treatment with magnesium and calcium channel blockers, the patient’s visual acuity remained poor. DISCUSSION: Excessive induced hypertension for spinal cord protection could rarely lead to cerebral vascular dysfunction, resulting in irreversible neurological damage. Awareness of this rare but devastating complication may help in early diagnosis, potentially mitigating permanent sequelae.
format Online
Article
Text
id pubmed-10025093
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-100250932023-03-21 Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement Yoshida, Soshi Koizumi, Shigeki Koyama, Tadaaki EJVES Vasc Forum Case Report INTRODUCTION: Induced hypertension, administered peri-operatively during thoraco-abdominal aortic intervention, is one of the most effective methods to maintain spinal cord perfusion pressure. Posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome is a rare encephalopathy, possibly caused by excessive hypertension, usually encountered in the obstetric or cerebrovascular department. REPORT: A 61 year old man underwent open surgery for repair of an extent II dissecting thoraco-abdominal aneurysm. Several attempts at spinal drainage tube insertion one day prior to surgery failed. The Adamkiewicz artery was anastomosed by bypass, and transcranial motor evoked potentials were generally stable. Initially, no apparent neurological abnormality was observed after surgery; however, paraplegia occurred on post-operative day 1. The patient’s mean arterial pressure increased from > 85 mmHg to > 95 mmHg. His systolic blood pressure occasionally exceeded 170 mmHg. On post-operative day 3 he became blind. A serial imaging test revealed cerebral oedema of both posterior lobes and segmental constriction of the vertebral and basilar arteries. Posterior reversible encephalopathy syndrome with reversible cerebral vasoconstriction syndrome was diagnosed from the clinical context and imaging tests. Despite treatment with magnesium and calcium channel blockers, the patient’s visual acuity remained poor. DISCUSSION: Excessive induced hypertension for spinal cord protection could rarely lead to cerebral vascular dysfunction, resulting in irreversible neurological damage. Awareness of this rare but devastating complication may help in early diagnosis, potentially mitigating permanent sequelae. Elsevier 2023-02-24 /pmc/articles/PMC10025093/ /pubmed/36949864 http://dx.doi.org/10.1016/j.ejvsvf.2023.02.001 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Yoshida, Soshi
Koizumi, Shigeki
Koyama, Tadaaki
Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement
title Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement
title_full Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement
title_fullStr Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement
title_full_unstemmed Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement
title_short Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement
title_sort posterior reversible encephalopathy syndrome after thoraco-abdominal aortic replacement
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025093/
https://www.ncbi.nlm.nih.gov/pubmed/36949864
http://dx.doi.org/10.1016/j.ejvsvf.2023.02.001
work_keys_str_mv AT yoshidasoshi posteriorreversibleencephalopathysyndromeafterthoracoabdominalaorticreplacement
AT koizumishigeki posteriorreversibleencephalopathysyndromeafterthoracoabdominalaorticreplacement
AT koyamatadaaki posteriorreversibleencephalopathysyndromeafterthoracoabdominalaorticreplacement