title: [Postoperative visual loss due to conversion disorder after spine surgery: a case report].
abstract: OBJECTIVE
  Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder.
  
  
  METHODS
  A male patient, 39 years old, 71kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30minutes, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms.
  
  
  CONCLUSIONS
  Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis.
authors.affiliation: Centro de Ensino e Treinamento Dr. José Quinan, Goiânia, GO, Brasil; Defesa Profissional da Sociedade de Anestesiologia do Estado de Goiás (2015/2016), Goiânia, GO, Brasil; Universidade Estadual Paulista Júlio de Mesquita Filho (FMB/Unesp), Faculdade de Medicina, Botucatu, SP, Brasil. Electronic address: dailsonbezerra@yahoo.com.br.
authors.forename: Dailson Mamede
authors.initials: DM
authors.lastname: Bezerra
authors.affiliation: Hospital Adventista de Belém, Serviço de Anestesiologia, Belém, PA, Brasil.
authors.forename: Eglantine Mamede
authors.initials: EM
authors.lastname: Bezerra
authors.affiliation: Hospital Adventista de Belém, Serviço de Anestesiologia, Belém, PA, Brasil.
authors.forename: Antonio Jorge
authors.initials: AJ
authors.lastname: Silva Junior
authors.affiliation: Centro de Ensino e Treinamento Dr. José Quinan, Goiânia, GO, Brasil.
authors.forename: Marco Aurélio Soares
authors.initials: MAS
authors.lastname: Amorim
authors.affiliation: Pontifícia Universidade Católica de Goiás (PUC/GO), Goiânia, GO, Brasil; Universidade Federal de Goiás (UFG), Goiânia, GO, Brasil.
authors.forename: Denismar Borges de
authors.initials: DB
authors.lastname: Miranda
mesh_terms: D000328:Adult; D001766:Blindness / Q000209:etiology*; D003291:Conversion Disorder / Q000150:complications*; D017586:Diskectomy; D006801:Humans; D007796:Laminectomy; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D013123:Spinal Fusion
keywords: Anestesia geral; Blindness; Cegueira; Conversion disorder; Decubitus ventral; Decúbito ventral; General anesthesia; Laminectomia; Laminectomy; Transtorno conversivo