title: Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses.
abstract: The purpose of our paper is to present a case of a rare complication of posterior lumbar surgery. Our patient presented for elective lumbar decompression, which was complicated by durotomy. She then developed sudden headache and right eye pain once upright on postoperative day 2. Then on postoperative day 3, she developed a dilated nonreactive pupil with extraocular movements intact. A computed tomography scan of the head was negative for subarachnoid hemorrhage. Magnetic resonance angiography showed a possible right posterior communicating artery aneurysm. She was transferred to a tertiary center with a severe headache and a nonreactive pupil, raising concern for evolving third nerve palsy due to aneurysm. A cerebral angiogram was performed and showed multiple aneurysms. Aneurysm location did not explain the patient's symptoms, and ophthalmology was consulted. Elevated intraocular pressure was noted, and the patient was diagnosed with acute angle-closure glaucoma (AACG). Our patient was medically treated and subsequently underwent laser peripheral iridotomy. She has had improved vision and pupillary function at 1 month follow-up. The diagnosis is complicated by a durotomy, which led to cascade in the differential diagnosis to rule out intracranial pathology. Her age and home medications, which had sympathomimetic effects, placed her at increased risk, but lying prone in the dark under the drapes was likely the lead causative factor. In conclusion, a postoperative posterior spine patient with eye pain and changes in vision and pupils should be evaluated with AACG in mind due to the devastating consequences if left untreated or treatment is delayed.
authors.affiliation: Louisiana State University Health Sciences Center Shreveport Department of Neurosurgery, Shreveport, Louisiana, USA. Electronic address: cstore@lsuhsc.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Storey
authors.affiliation: Louisiana State University Health Sciences Center Shreveport Department of Neurosurgery, Shreveport, Louisiana, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Menger
authors.affiliation: Louisiana State University Health Sciences Center Shreveport Department of Neurosurgery, Shreveport, Louisiana, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hefner
authors.affiliation: Louisiana State University Health Sciences Center Shreveport Department of Neurosurgery, Shreveport, Louisiana, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Keating
authors.affiliation: Louisiana State University Health Sciences Center Shreveport Department of Neurosurgery, Shreveport, Louisiana, USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Louisiana State University Health Sciences Center Shreveport Department of Neurosurgery, Shreveport, Louisiana, USA.
authors.forename: Bharat
authors.initials: B
authors.lastname: Guthikonda
mesh_terms: D000368:Aged; D019299:Decompression, Surgical; D004388:Dura Mater / Q000293:injuries; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D015840:Oculomotor Nerve Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D014786:Vision Disorders / Q000209:etiology
keywords: Acute closed-angle glaucoma; Cerebral aneurysm; Durotomy; Lumbar; Postoperative complication; Spine surgery