ABSTRACT
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic condition encountered in many different clinical settings; it generally occurs in the context of hypertensive crisis, immunosuppressive therapy, or autoimmune diseases. It is characterized by headache, stupor, seizures, and visual alterations. Magnetic resonance imaging findings include white matter changes preferentially in the parieto-occipital regions. Although pathogenesis is not fully elucidated, vasoconstriction and brain hypoperfusion seem to be the cause of brain ischemia and vasogenic edema. Cerebrospinal fluid hypotension is also a reported plausible pathogenic mechanism. CASE DESCRIPTION: We present a case of PRES following laminectomy and fixation for L4-5 lumbar stenosis and spondylolisthesis. The patient presented with status epilepticus immediately after surgery that lasted 5 days. Brain magnetic resonance imaging showed fluid attenuated inversion recovery and T2 hyperintensities in the bilateral parietal and occipital lobes and external capsules. On the basis of postoperative lumbar images, we hypothesized that an unnoticed cerebrospinal fluid leak might have contributed to development of PRES. The patient developed multiple postoperative complications but ultimately recovered after treatment for severe hypertension and seizures. CONCLUSIONS: Prompt recognition and treatment of this potentially life-threatening syndrome is necessary to increase the likelihood of favorable outcome. Spinal surgeons need to be aware of the possibility of neurologic deterioration after spinal surgery and be alert about the occurrence of a dural leak, either recognized or unnoticed, as the plausible mechanism triggering PRES.
Subject(s)
Constriction, Pathologic/surgery , Neurosurgical Procedures/adverse effects , Posterior Leukoencephalopathy Syndrome/etiology , Postoperative Complications/etiology , Spondylolisthesis/surgery , Status Epilepticus/etiology , Aged, 80 and over , Constriction, Pathologic/complications , Constriction, Pathologic/diagnostic imaging , Electroencephalography , Female , Follow-Up Studies , Humans , Laminectomy/adverse effects , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Postoperative Complications/diagnostic imaging , Spondylolisthesis/complications , Spondylolisthesis/diagnostic imaging , Status Epilepticus/complications , Status Epilepticus/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Se presenta el caso clínico de una endocarditis infecciosa tricúspidea por Staphylococcus aureus en una mujer joven con probable puerta de entrada ginecológica. Se pone de relevancia su prolongada evolución y severas complicaciones: neumopatía derecha, infartos pulmonares múltiples, insuficiencia cardíaca aguda predominio derecho y rotura esplénica posterior a punción abdominal. Se trató con éxito con cloxacilina, gentamicina, cefotaxima y anticoagulantes. Se discuten implicaciones etiológicas, clínicas y diagnósticos de estos casos
