Postoperative visual loss due to conversion disorder after spine surgery: a case report

Detalhes bibliográficos
Autor(a) principal: Bezerra, Dailson Mamede [UNESP]
Data de Publicação: 2018
Outros Autores: Bezerra, Eglantine Mamede, Silva Junior, Antonio Jorge, Soares Amorim, Marco Aurelio, Miranda, Denismar Borges de
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.1016/j.bjane.2015.03.005
http://hdl.handle.net/11449/160070
Resumo: Background and objective: Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. Case report: A male patient, 39 years old, 71 kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0 mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30 min, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conclusions: Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. (C) 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.
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spelling Postoperative visual loss due to conversion disorder after spine surgery: a case reportGeneral anesthesiaBlindnessConversion disorderLaminectomyDecubitus ventralBackground and objective: Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. Case report: A male patient, 39 years old, 71 kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0 mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30 min, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conclusions: Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. (C) 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.Ctr Ensino & Treinamento Dr Jose Quinan, Goiania, Go, BrazilSoc Anestesiol Estado Goias 2015 2016, Goiania, Go, BrazilUniv Estadual Paulista Julio de Mesquita Filho FM, Fac Med, Botucatu, SP, BrazilHosp Adventista Belem, Serv Anestesiol, Belem, Para, BrazilPontificia Univ Catolica Goias PUC GO, Goiania, Go, BrazilUniv Fed Goias, Goiania, Go, BrazilUniv Estadual Paulista Julio de Mesquita Filho FM, Fac Med, Botucatu, SP, BrazilElsevier B.V.Ctr Ensino & Treinamento Dr Jose QuinanSoc Anestesiol Estado Goias 2015 2016Universidade Estadual Paulista (Unesp)Hosp Adventista BelemPontificia Univ Catolica Goias PUC GOUniversidade Federal de Goiás (UFG)Bezerra, Dailson Mamede [UNESP]Bezerra, Eglantine MamedeSilva Junior, Antonio JorgeSoares Amorim, Marco AurelioMiranda, Denismar Borges de2018-11-26T15:47:23Z2018-11-26T15:47:23Z2018-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article91-95application/pdfhttp://dx.doi.org/10.1016/j.bjane.2015.03.005Revista Brasileira De Anestesiologia. New York: Elsevier Science Inc, v. 68, n. 1, p. 91-95, 2018.0034-7094http://hdl.handle.net/11449/16007010.1016/j.bjane.2015.03.005WOS:000424375300010WOS000424375300010.pdfWeb of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengRevista Brasileira De Anestesiologia0,320info:eu-repo/semantics/openAccess2023-11-10T06:11:36Zoai:repositorio.unesp.br:11449/160070Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-11-10T06:11:36Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Postoperative visual loss due to conversion disorder after spine surgery: a case report
title Postoperative visual loss due to conversion disorder after spine surgery: a case report
spellingShingle Postoperative visual loss due to conversion disorder after spine surgery: a case report
Bezerra, Dailson Mamede [UNESP]
General anesthesia
Blindness
Conversion disorder
Laminectomy
Decubitus ventral
title_short Postoperative visual loss due to conversion disorder after spine surgery: a case report
title_full Postoperative visual loss due to conversion disorder after spine surgery: a case report
title_fullStr Postoperative visual loss due to conversion disorder after spine surgery: a case report
title_full_unstemmed Postoperative visual loss due to conversion disorder after spine surgery: a case report
title_sort Postoperative visual loss due to conversion disorder after spine surgery: a case report
author Bezerra, Dailson Mamede [UNESP]
author_facet Bezerra, Dailson Mamede [UNESP]
Bezerra, Eglantine Mamede
Silva Junior, Antonio Jorge
Soares Amorim, Marco Aurelio
Miranda, Denismar Borges de
author_role author
author2 Bezerra, Eglantine Mamede
Silva Junior, Antonio Jorge
Soares Amorim, Marco Aurelio
Miranda, Denismar Borges de
author2_role author
author
author
author
dc.contributor.none.fl_str_mv Ctr Ensino & Treinamento Dr Jose Quinan
Soc Anestesiol Estado Goias 2015 2016
Universidade Estadual Paulista (Unesp)
Hosp Adventista Belem
Pontificia Univ Catolica Goias PUC GO
Universidade Federal de Goiás (UFG)
dc.contributor.author.fl_str_mv Bezerra, Dailson Mamede [UNESP]
Bezerra, Eglantine Mamede
Silva Junior, Antonio Jorge
Soares Amorim, Marco Aurelio
Miranda, Denismar Borges de
dc.subject.por.fl_str_mv General anesthesia
Blindness
Conversion disorder
Laminectomy
Decubitus ventral
topic General anesthesia
Blindness
Conversion disorder
Laminectomy
Decubitus ventral
description Background and objective: Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. Case report: A male patient, 39 years old, 71 kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0 mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30 min, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conclusions: Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. (C) 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.
publishDate 2018
dc.date.none.fl_str_mv 2018-11-26T15:47:23Z
2018-11-26T15:47:23Z
2018-01-01
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1016/j.bjane.2015.03.005
Revista Brasileira De Anestesiologia. New York: Elsevier Science Inc, v. 68, n. 1, p. 91-95, 2018.
0034-7094
http://hdl.handle.net/11449/160070
10.1016/j.bjane.2015.03.005
WOS:000424375300010
WOS000424375300010.pdf
url http://dx.doi.org/10.1016/j.bjane.2015.03.005
http://hdl.handle.net/11449/160070
identifier_str_mv Revista Brasileira De Anestesiologia. New York: Elsevier Science Inc, v. 68, n. 1, p. 91-95, 2018.
0034-7094
10.1016/j.bjane.2015.03.005
WOS:000424375300010
WOS000424375300010.pdf
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Revista Brasileira De Anestesiologia
0,320
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 91-95
application/pdf
dc.publisher.none.fl_str_mv Elsevier B.V.
publisher.none.fl_str_mv Elsevier B.V.
dc.source.none.fl_str_mv Web of Science
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv
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