Postoperative Idiopathic Posterior Reversible Encephalopathy Syndrome- A Rare Case Report

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental functioning, seizures and loss of vision associated with posterior leukoencephalopathy on the imaging studies. The clinical symptom complex as well as the abnormalities in imaging usually resolves within a week with effective management. We report a case of PRES in an operated case of gastric malignancy with no major recognized risk factors other than one episode of mild hypertension and incidentally detected supracardiac partial anomalous venous return.

Case Presentation: A 55-year-old lady underwent D2 subtotal gastrectomy under general anesthesia and epidural analgesia for gastric outlet obstruction secondary to a poorly differentiated gastric adeno-carcinoma. On the first postoperative day she reported sudden loss of vision. Clinical examination revealed presence of bilateral light reflex with absence of visual perception in both the eyes. All necessary examinations and investigations including MRI performed. She was able to regain light perception in the right eye on the 5th postoperative day which was followed by successful finger counting and face recognition within the next couple of days. The patient was well with normal visual acuity in both eyes on follow up at 10 months after discharge.

Conclusion: Sudden development of neurological manifestations in the immediate postoperative period should alert the surgeon regarding PRES. Classical clinical history, detail neurological examination supported by neuroimaging clinches the diagnosis of PRES. Prompt and effective treatment results in excellent prognosis in this serious and treatable disease.