CC BY-NC-ND 4.0 · J Neurol Surg Rep 2022; 83(02): e50-e53
DOI: 10.1055/s-0042-1749403
Original Article

Atypical Posterior Reversible Encephalopathy Syndrome in Intraorbital Lymphoma after Tumor Biopsy: An Illustrative Case

Jirapong Vongsfak
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
,
Thunya Norasethada
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
,
Kittisak Unsrisong
2   Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
› Author Affiliations
Funding The article processing fee for Open Access Publishing was provided by the Research Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University.

Abstract

Introduction A 63-year-old male presented with visual loss and left eye proptosis. Magnetic resonance imaging revealed a left orbital tumor, measuring 1.4 cm × 0.9 cm. The patient underwent left frontotemporal craniotomy to perform a biopsy of the tumor. During the postoperative period, the patient developed the first episode of a generalized tonic–clonic seizure.

Case Summary Computed tomography of the brain showed hypodensity of the bilateral basal ganglia and thalami with associated edematous white matter hypodensity of bilateral temporo-occipital lobes compatible with atypical posterior reversible encephalopathy syndrome (PRES). The patient received antiepileptic medication and was observed for clinical seizure. One week later, computed tomography of the brain showed the reversible process of PRES. The pathology report revealed diffuse large B cell lymphoma. Following pathological diagnosis, the patient received treatment with whole-brain radiotherapy.

Conclusion This is the first reported case of atypical PRES associated with orbital lymphoma following craniotomy for the purpose of tumor biopsy. Early detection as well as seizure and blood pressure control, is essential for the proper treatment of PRES.



Publication History

Received: 26 May 2021

Accepted: 30 March 2022

Article published online:
24 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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