Clinical Case of Posterior Reversible Encephalopathy Syndrome in a Female Patient Undergoing Surgery for Rectal Cancer

Introduction. Posterior reversible encephalopathy syndrome (PRES) refers to a relatively obscure syndrome with unclear pathogenesis, leading to patient disability, occurring in 58% of cases against a background of arterial hypertension. Clinical manifestations include cephalalgia, epileptic seizures, and visual disturbances, potentially culminating in complete blindness. The clinical case represents a rare life-threatening condition that may pose challenges for an attending physician regarding the appropriate therapeutic strategy.

Aim. To demonstrate the occurrence of posterior reversible encephalopathy syndrome during an anterior resection of the rectum, as well as to discuss the correct therapeutic strategy.

Materials and methods. A 63-year-old female patient with a history of chronic arterial hypertension was admitted for surgical intervention due to rectal cancer. The operation was performed under general anesthesia and marked by unstable hemodynamics, with blood pressure rising to 160/100 mmHg. After awakening, the patient exhibited loss of vision and coordination disturbances, accompanied by uncontrolled arterial hypertension, with blood pressure rising to 182/130 mmHg. Magnetic resonance imaging revealed areas of hyperintense signal bilaterally in the occipital lobes without signs of diffusion restriction. The neurological deficits were managed through a comprehensive therapeutic regimen, utilizing nootropics, antioxidants, and antihypoxic agents, in conjunction with appropriate antihypertensive treatment. Vision was restored within two weeks.

Results and discussion. The management of posterior reversible encephalopathy syndrome following a hypertensive crisis during surgical intervention should encompass etiological treatment, alongside correction of neurological symptoms utilizing relevant pharmacological agents. An appropriate and timely treatment obtains high potential to resolve the syndrome.

Conclusion. Posterior reversible encephalopathy syndrome may develop in patients with a history of arterial hypertension and manifest as a sudden onset of hemodynamic instability during and after surgical intervention, potentially leading to cortical blindness. In such cases, antihypertensive therapy, in conjunction with corrective medications, is advisable.