Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
J Anesth. 2012 Feb;26(1):111-4. doi: 10.1007/s00540-011-1256-7. Epub 2011 Oct 20.
Posterior reversible encephalopathy syndrome (PRES) is a relatively new clinical entity characterized by reversible neurological symptoms with findings indicating leukoencephalopathy on imaging studies. Reports of PRES in the field of anesthesiology have been quite limited. A patient with therapeutic anticoagulant developed PRES immediately after emergence from anesthesia, in which her status was initially recognized as delayed recovery from anesthesia with transient hypertension because an emergent head computed tomography (CT) scan was almost normal. Subsequently, magnetic resonance imaging (MRI) was also performed according to a radiologist's recommendation because the CT results showed areas of slightly low attenuation in the frontoparieto-occipital lobes bilaterally, suggesting PRES; otherwise, ischemic events. MRI showed subcortical increased T(2) and fluid-attenuated inversion recovery (FLAIR) intensity in the occipitoparietal regions bilaterally with slight increase in the apparent diffusion coefficient signal on diffusion-weighted imaging, which confirmed a diagnosis of PRES. Gradually, the patient regained consciousness and became responsive with antihypertensive therapy. A prompt and accurate diagnosis of PRES is important to avoid irreversible brain damage, for example, intracranial hemorrhage, especially in a patient receiving anticoagulation therapy.
后部可逆性脑病综合征（PRES）是一种相对较新的临床实体，其特征是影像学检查显示白质脑病的可逆性神经症状。麻醉学领域关于 PRES 的报道非常有限。一名接受治疗性抗凝治疗的患者在麻醉苏醒后立即出现 PRES，其最初的情况被认为是麻醉后恢复延迟伴有短暂性高血压，因为紧急头部计算机断层扫描（CT）几乎正常。随后，根据放射科医生的建议进行了磁共振成像（MRI）检查，因为 CT 结果显示双侧额顶枕叶有轻度低衰减区，提示 PRES；否则，为缺血性事件。MRI 显示双侧顶枕叶皮质下 T2 加权和液体衰减反转恢复（FLAIR）强度增加，弥散加权成像上表观弥散系数信号略有增加，证实了 PRES 的诊断。随着降压治疗的进行，患者逐渐恢复意识并对刺激有反应。及时准确地诊断 PRES 很重要，以避免不可逆的脑损伤，例如颅内出血，尤其是在接受抗凝治疗的患者中。
