A case of posterior reversible encephalopathy syndrome (PRES) after blood transfusion and hysterectomy in a patient with uterine myoma

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  • 輸血後に行った単純子宮全摘出術術後に可逆性後頭葉白質脳症（PRES）を発症した子宮筋腫の1例
  • 症例報告 輸血後に行った単純子宮全摘出術術後に可逆性後頭葉白質脳症(PRES)を発症した子宮筋腫の1例
  • ショウレイ ホウコク ユケツ ゴ ニ イッタ タンジュン シキュウ ゼン テキシュツジュツ ジュツゴ ニ カギャクセイ コウトウ ヨウ ハクシツ ノウショウ(PRES)オ ハッショウ シタ シキュウ キンシュ ノ 1レイ

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is clinically characterized by seizures, headaches, altered consciousness, and loss of vision. Reversible subcortical edema in the occipital and parietal lobes without infarction is the key feature identified on neurological imaging. In previous reports, PRES has been associated with hypertensive encephalopathy, eclampsia, and immunosuppressive and chemotherapeutic drugs. We report a case of a 53-year-old woman with severe anemia (Hb: 3.8 g/dl) and a uterine myoma. After transfusion of eight units of red blood cells, her hemoglobin level increased to 8.4 g/dl. Fifty days after blood transfusion, she underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. In the morning of the day of the operation, she was normotensive (116/70 mmHg). Immediately prior to surgery, her blood pressure increased to 177/84 mmHg, and intraoperatively, it increased to 180/96 mmHg. Three hours after surgery, she had generalized tonic clonic seizures and stupor. Cranial CT scan revealed no abnormalities at that time. She was administered antiepileptic drugs. Cranial T2FLAIR MRI performed three days later showed increased signal intensity in the occipital lobe region bilaterally. She recovered consciousness that day and was diagnosed with PRES. Nine days later, cortical blindness developed. Although the results of the MRI performed 37 days later revealed diminished lesions, she still suffered from epileptic seizures. Previous reports indicated that PRES after blood transfusion or a surgical operation occurs almost only in women. In the present case, we postulate that severe changes in blood pressure around the time of surgery caused PRES to occur and that blood transfusion might affect the occurrence of PRES. Blood transfusions can increase the risk of PRES. When symptoms of PRES appear after blood transfusion, immediate therapy should be considered. [Adv Obstet Gynecol, 67 (3) : 307-313, 2015 (H27.8)]

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