Posterior Reversible Encephalopathy Syndrome Causing Vision Loss Following Endoscopic Endonasal Resection of Pituitary Adenoma: A Case Report.

Posterior Reversible Encephalopathy Syndrome Causing Vision Loss Following Endoscopic Endonasal Resection of Pituitary Adenoma: A Case Report.

World Neurosurg. 2017 Feb 15;:

Authors: Villelli NW, Prevedello DM, Ikeda DS, Montaser AS, Otto BA, Carrau RL

Abstract
BACKGROUND: Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by headache, altered mental status, visual changes, and seizure combined with brain imaging consistent with cerebral edema without infarction. To the best of our knowledge, we report the first case of PRES following an endoscopic endonasal resection of a pituitary macroadenoma.
CASE DESCRIPTION: A 59-year-old female was diagnosed with a pituitary macroadenoma, for which she underwent endoscopic endonasal extracapsular resection. After an uneventful initial post-operative recovery, the patient experienced sudden onset of emesis, confusion, vision loss, and severe hypertension. Emergent CT demonstrated normal post-operative changes, with no signs of hematoma or infarction. MRI revealed FLAIR changes in the posterior lobes and thalamus, consistent with PRES. Cerebral angiogram demonstrated no vascular abnormalities. Blood pressure control was the primary treatment modality. Within ten days, she was neurologically intact except for right homonymous hemianopsia. Follow-up MRI revealed resolution of the PRES with an area of infarction in the left occipital lobe. At five-years follow-up, the patient reported minimal blurred vision. MRI demonstrated encephalomalacia at the old infarct area, and her visual field testing was unremarkable.
CONCLUSION: Although rare in neurosurgical patients, PRES must be considered in patients who develop acute vision loss and mental status changes associated with hypertension following surgery, including endoscopic endonasal surgery. PRES has the potential for significant neurological morbidity, if not treated in a timely manner. Early recognition and treatment, with blood pressure control mainly, is therefore mandatory after a surgical complication, such as a post-operative hematoma, has been ruled out.

PMID: 28214641 [PubMed - as supplied by publisher]

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