Posterior Reversible Encephalopathy Syndrome in a Patient with Spinal Metastasis

Abstract

Corresponding Author: Ju Ho Jeong, M.D., Ph.D. Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, 87 Dongdaero, Gyeongju 38067, Korea Tel: +82-54-770-8232 Fax: +82-54-770-8378 E-mail: ktokhou@gmail.com Posterior reversible encephalopathy syndrome (PRES), also named reversible posterior leukoencephalopathy, is not a familiar term to neurosurgeon. The PRES is characterized by various kinds of neurologic signs and symptoms that include headache, seizure, altered mental status, lethalgy, visual loss and focal neurological disability. A 63-year-old female visited with upper back pain and both leg weakness. She has been receiving chemotherapy with gemcitabine and cisplatin for lung cancer with multiple bone metastasis. According to the imaging, we diagnosed the patient as T8 pathologic fracture. Five days after surgical decompression, she suddenly complained of visual loss. Magnetic resonance imaging(MRI) of the brain showed bilateral subcortical and cortical edema in the parieto-occipital area. Her MRI finding and symptoms suggested the PRES. Five days after conservative treatment, her visual disturbance was completely recovered. We believe that accurate and early detection of PRES and adequate treatment is very important for the patient having a history of chemotherapy.