Vongsfak Jirapong, Norasethada Thunya, Unsrisong Kittisak
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Neurol Surg Rep. 2022 Jun 24;83(2):e50-e53. doi: 10.1055/s-0042-1749403. eCollection 2022 Apr.
A 63-year-old male presented with visual loss and left eye proptosis. Magnetic resonance imaging revealed a left orbital tumor, measuring 1.4 cm × 0.9 cm. The patient underwent left frontotemporal craniotomy to perform a biopsy of the tumor. During the postoperative period, the patient developed the first episode of a generalized tonic-clonic seizure. Computed tomography of the brain showed hypodensity of the bilateral basal ganglia and thalami with associated edematous white matter hypodensity of bilateral temporo-occipital lobes compatible with atypical posterior reversible encephalopathy syndrome (PRES). The patient received antiepileptic medication and was observed for clinical seizure. One week later, computed tomography of the brain showed the reversible process of PRES. The pathology report revealed diffuse large B cell lymphoma. Following pathological diagnosis, the patient received treatment with whole-brain radiotherapy. This is the first reported case of atypical PRES associated with orbital lymphoma following craniotomy for the purpose of tumor biopsy. Early detection as well as seizure and blood pressure control, is essential for the proper treatment of PRES.
一名63岁男性因视力丧失和左眼突出就诊。磁共振成像显示左侧眼眶有一个肿瘤，大小为1.4厘米×0.9厘米。患者接受了左额颞开颅手术以对肿瘤进行活检。术后，患者出现了首次全身性强直阵挛发作。脑部计算机断层扫描显示双侧基底神经节和丘脑低密度，伴有双侧颞枕叶相关的水肿性白质低密度，符合非典型后部可逆性脑病综合征（PRES）。患者接受了抗癫痫药物治疗并观察临床癫痫发作情况。一周后，脑部计算机断层扫描显示PRES的可逆过程。病理报告显示为弥漫性大B细胞淋巴瘤。病理诊断后，患者接受了全脑放疗。这是首例因肿瘤活检行开颅术后出现与眼眶淋巴瘤相关的非典型PRES的报道病例。早期发现以及癫痫发作和血压控制对于PRES的恰当治疗至关重要。
