Posterior Reversible Encephalopathy Syndrome following Laparoscopic Roux-en- y Gastric Bypass

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical radiographic pathology that is not always reversible. PRES is associated with headaches, decreased level of consciousness, visual disturbances, seizures, and posterior white matter edema in neuroimaging. Results: We report...

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Published in:Obesity (Silver Spring, Md.) Md.), 2021-12, Vol.29, p.143-143
Main Authors: Cardona-Gonzalez, Osvaldo, Rovira, Omar, Rodriguez-Rivera, Laura, Bolanos, Guillermo
Format: Article
Language:English
Subjects:
Blood pressure
Electrolytes
Gastrointestinal surgery
Laparoscopy
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Summary:Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical radiographic pathology that is not always reversible. PRES is associated with headaches, decreased level of consciousness, visual disturbances, seizures, and posterior white matter edema in neuroimaging. Results: We report a case of a 52-year-old female, with a past medical history of morbid obesity, hypertension, type II diabetes mellitus, fibromyalgia, obstructive sleep apnea, and surgical history of recent laparoscopic bariatric gastric bypass, and a previous total abdominal hysterectomy. The patient presented to the emergency department with uncontrolled emesis, headache, visual disturbances, confusion, generalized tonic-clonic seizure, and uncontrolled blood pressure. Upon admission, the patient was found to have severe hypomagnesemia (0.96mg/dL), moderate hypokalemia (2.9mmol/L), and vitamin derangements. A head CT scan was performed which was unremarkable, however, an MRI revealed increased signals in the T2 flairs at the occipital regions suggesting posterior reversible encephalopathy syndrome (PRES). Subsequently, a neurologist confirmed the diagnosis of PRES in this patient. Conclusions: The patient was initiated on seizure prophylaxis and was treated with steroids, antiplatelet, statins, antihypertensive medications. Electrolytes were replaced, and multivitamin supplementation was provided. Resolution of the symptoms was achieved and the patient was discharged home after 6 days of treatment. Follow-up MRI demonstrated improvement of previous occipital white matter findings. Multiple risk factors for the development of PRES were present in this patient such as recent bariatric surgery, electrolytes disturbances, and uncontrolled blood pressure.
ISSN:1930-7381
1930-739X