J Neurocrit Care.  2017 Jun;10(1):32-35. 10.18700/jnc.170005.

Phenylephrine Induced Posterior Reversible Encephalopathy Syndrome during Resection of Solitary Pulmonary Nodule

• Hong SH
• Park YK
• Yoon B
• Lee KO
• Kim YD
• Na SJ

• KMID: 2385884
• DOI: http://doi.org/10.18700/jnc.170005

Abstract

BACKGROUND
Posterior reversible encephalopathy syndrome (PRES) is a neurological complication caused by cerebral hyperperfusion.
CASE REPORT
A 46-year-old male presented with decreased mental status, left facial palsy, and left-sided weakness after video-assisted thoracoscopic surgery for a solitary pulmonary nodule. During the surgery, phenylephrine was infused intravenously for general anesthesia-induced hypotension. High signal intensity at the right parietooccipital lobe was noted on fluid-attenuated inversion recovering imaging and diffusion-weighted imaging. His neurological symptoms improved two days after initial presentation. Follow-up diffusion-weighted imaging showed resolution of the brain lesions 10 days after the surgery.
CONCLUSIONS
We report a patient who presented with PRES after administration of phenylephrine during resection of a solitary pulmonary nodule. PRES should be considered for patients presented with acute neurologic symptoms following surgical procedures.

Keyword

Posterior reversible encephalopathy syndrome; Phenylephrine; Hypertension

MeSH Terms

Brain
Facial Paralysis
Follow-Up Studies
Humans
Hypertension
Hypotension
Male
Middle Aged
Neurologic Manifestations
Phenylephrine*
Posterior Leukoencephalopathy Syndrome*
Solitary Pulmonary Nodule*
Thoracic Surgery, Video-Assisted
Phenylephrine

Figure

• 

  Figure 1. Brain MRI and MRA of the patient at the symptom onset. Fluid-attenuated inversion recovering imaging (FLAIR) (A) and diffusion-weighted imaging (DWI) showed regional hyperintensity in the right parietooccipital area (B), and apparent diffusion coefficent (ADC) map in corresponding area showed hypointense signal, suggesting cytotoxic edema (C). MRA angiography shows normal findings in the intracranial and internal carotid arteries (D). MRI, magnetic resonance imaging; MRA, magnetic resonance angiography.

• 

  Figure 2. Follow-up MRI of the patient after 10 days. DWI showed decreased signal intensities in the right parietoocipital subcortical area (A), and the ADC map were almost resolved, except for small foci of cerebral infarction (B). DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.

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