title: Posterior reversible encephalopathy syndrome (PRES) after bariatric surgery--a potential consequence associated with rapid withdrawal of antihypertensive medications.
abstract: A 61-year-old woman with a medical history of intracerebral haemorrhage, hypertension, hyperlipidaemia and carotid stenosis presented to the emergency department with altered mental status 3 weeks after undergoing a vertical sleeve gastrectomy for severe obesity. She presented with a hypertensive emergency and a National Institutes of Health Stroke Scale of 4. CT of the head was unrevealing. MRI showed an abnormal signal within the bilateral posterior border-zone areas, with several foci in the parietal and occipital lobes, and thalami, suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was initially placed on a labetalol drip and her preoperative antihypertensive medications--amlodipine, captopril, triamterene and hydrochlorothiazide--were gradually reintroduced. She returned to her baseline and was stable on discharge. Rapid withdrawal of antihypertensive medications in the early postoperative period of bariatric surgery was the aetiology of PRES in this patient. This case report discusses postoperative care of bariatric surgery patients having hypertension.
authors.affiliation: Department of Medicine- Gastroenterology and Department of Pediatrics, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Fatima Cody
authors.identifier: http://orcid.org/0000-0003-4616-533X
authors.initials: FC
authors.lastname: Stanford
authors.affiliation: Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Janey S
authors.identifier: http://orcid.org/0000-0002-6850-3427
authors.initials: JS
authors.lastname: Pratt
authors.affiliation: Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ozanan R
authors.initials: OR
authors.lastname: Meireles
authors.affiliation: Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Bredella
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology*; D011184:Postoperative Period
chemical_list: D000959:Antihypertensive Agents