Postoperative blindness associated with posterior reversible encephalopathy syndrome: a case report

We report the case of a 46-year-old woman presenting with postoperative bilateral cerebral visual loss that was initially misinterpreted as an irreversible ischemic event. Magnetic resonance imaging of the brain showed high signal intensity on T2-weighted and fluid-attenuated inversion recovery images and normal signal intensity on diffusion-weighted images of the posterior lobe, which mostly disappeared with the improvement of clinical symptoms. Subsequent diagnosis revealed posterior reversible encephalopathy syndrome (PRES). Recognition of PRES as the correct diagnosis led to the appropriate management strategy and the recovery of normal vision. Differentiation from acute cerebral ischemia is important in order to prevent permanent vision loss due to delay in initiating prompt and vigorous treatment of exacerbating factors, such as intermittent hypertension. We believe that it is important for anesthesiologists and critical care physicians to accurately diagnose PRES in view of the key differences in the management of similarly presenting conditions.