Posterior reversible encephalopathy syndrome following a thoracic discectomy-induced dural leak: case report.
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headaches, altered mental status, seizures, and visual disturbances. Classic MRI findings include white matter changes of the parieto-occipital regions. This syndrome has been encountered in myriad medical illnesses, including hypertension, preeclampsia/eclampsia, and immunosuppressive conditions. While the pathogenesis of the disorder is unclear, vasoconstriction and hypoperfusion leading to brain ischemia and vasogenic edema have been implicated as potential mechanisms. The authors present, to the best of their knowledge, the first case of PRES following a thoracic spinal surgery-induced dural leak noted on resection of the fifth rib during a thoracotomy for a T4-5 discectomy. Brain MRI revealed large areas of increased FLAIR and T2 hyperintensity in the superior posterior frontal lobes, superior and medial parietal lobes, and bilateral occipital lobes. Following repair of the CSF leak, the patient's symptoms resolved. Spinal surgeons should be alert to the potentially life-threatening condition of PRES, especially in a hypertensive patient who experiences surgery-induced dural leakage. The development of a severe positional headache with neurological signs is a red flag that suggests the presence of PRES. Prompt attention to the diagnosis and treatment of this condition by repairing the dural leak via surgery or expeditious blood patch increases the likelihood of a favorable outcome.
Norton Neuroscience Institute.|Norton Healthcare; and.
Lisa B E
LB
Shields
Norton Healthcare; and.
John R
JR
Johnson
Norton Neuroscience Institute.|Norton Healthcare; and.|Department of Anatomical Science and Neurobiology, University of Louisville, School of Medicine, Louisville, Kentucky.
Christopher B
CB
Shields
D001921:Brain / Q000000981:diagnostic imaging; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D003937:Diagnosis, Differential; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012272:Ribs / Q000000981:diagnostic imaging / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*
BBB = blood-brain barrier; PRES; PRES = posterior reversible encephalopathy syndrome; TAA = thoracic aortic aneurysm; TAAA = thoracoabdominal aortic aneurysm; discectomy; dural leak; posterior reversible encephalopathy syndrome; thoracic