Posterior Reversible Encephalopathy Syndrome After Thoraco-Abdominal Aortic Replacement

EJVES Vascular Forum, 2023 · DOI: https://doi.org/10.1016/j.ejvsvf.2023.02.001 · Published: January 1, 2023

Cardiovascular Science Neurology Surgery

Simple Explanation

The case report discusses a rare brain condition called Posterior Reversible Encephalopathy Syndrome (PRES) that occurred after surgery to repair a thoraco-abdominal aortic aneurysm. The patient developed paraplegia (leg paralysis) and blindness after the surgery, which was linked to high blood pressure maintained during and after the procedure to protect the spinal cord. The report suggests that while maintaining high blood pressure is important for spinal cord protection during such surgeries, it can sometimes lead to serious brain complications like PRES, potentially causing irreversible neurological damage.

Study Duration

Not specified

Participants

A 61 year old man

Evidence Level

Level 4, Case Report

Key Findings

1
Excessive induced hypertension for spinal cord protection could lead to cerebral vascular dysfunction, resulting in irreversible neurological damage.
2
The patient developed PRES with reversible cerebral vasoconstriction syndrome (RCVS) after thoraco-abdominal aortic replacement surgery, manifesting as paraplegia and blindness.
3
Imaging tests revealed cerebral oedema of both posterior lobes and segmental constriction of the vertebral and basilar arteries.

Research Summary

The case report describes a 61-year-old man who developed paraplegia and blindness following thoraco-abdominal aortic aneurysm repair, later diagnosed as Posterior Reversible Encephalopathy Syndrome (PRES) with reversible cerebral vasoconstriction syndrome (RCVS). The patient's induced hypertension, aimed at spinal cord protection, likely contributed to cerebral vascular dysfunction, leading to these neurological complications. Despite treatment, the patient experienced persistent visual impairment and paraplegia, highlighting the potential for irreversible neurological damage from this rare complication.

Practical Implications

Awareness and Early Diagnosis

Increased awareness of PRES as a potential complication of induced hypertension during aortic aneurysm repair is crucial for early diagnosis.

Careful Blood Pressure Management

Careful monitoring and management of blood pressure during and after surgery are essential to balance spinal cord protection and minimize the risk of cerebral complications.

Differential Diagnosis

Clinicians should consider PRES in the differential diagnosis of neurological deficits occurring after aortic aneurysm repair, especially when accompanied by visual disturbances.

Study Limitations

1
Single case report limits generalizability.
2
Difficulty in distinguishing PRES from cerebral infarction can delay diagnosis.
3
MRI, the more sensitive imaging method, is difficult to perform in intubated post-operative patients.

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