An unusual case of posterior reversible encephalopathy syndrome in a patient being weaned from intrathecal morphine.
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity based on clinical signs, including headache, visual abnormalities, and seizures, and radiological abnormalities mostly consisting of vasogenic brain edema predominantly in the posterior parietal-temporal-occipital regions. PRES typically develops in the setting of a significant " systemic process", including preeclampsia, transplantation, infection/sepsis/shock, autoimmune disease, and cancer chemotherapy, in which hypertension often plays an important role. We present a case of PRES in a 63-year-old female patient with an infected intrathecal morphine pump on a cocktail of antibiotics, morphine, clonidine, diazepam, and amitriptyline. It is the first PRES case in a chronic pain patient, which illustrates that PRES can occur in the absence of any of the established risk factors. We hypothesize it may have been caused by antibiotic treatment in our patient.
Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
Jasper
J
Van Aalst
Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
Onno P
OP
Teernstra
Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.
Wim E
WE
Weber
Department of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands.
Kim
K
Rijkers
PRES; intrathecal morphine; neuropathic pain