Reactions 1357 - 25 Jun 2011

SRopivacaine

Reversible posterior leukoencephalopathysyndrome and hypotension: case report

A 59-year-old woman developed reversible posteriorleucoencephalopathy syndrome (RPLS) and hypotensionduring treatment with ropivacaine for abdominal paincontrol following a cholecystectomy.

The woman received ropivacaine 8-12 mg/hour via anepidural catheter everyday postoperatively. She had ahistory of chronic hypertension and also receivedcandesartan cilexetil to maintain her BP at around 150/80.Four days after the operation, she experienced a mildheadache on rising in the morning, and as her BP was89/46, she did not receive candesartan cilexetil. Whileeating breakfast, she experienced blurred vision in thelower half of the visual field. MRI revealed numerous high-intensity areas in bilateral occipital and right parietal andfrontal lobes. Intracranial magnetic resonance angiographyrevealed significant bilateral, diffuse peripheral arterialconstriction in the middle, anterior and posterior cerebralarteries.

The epidural catheter was removed and the womanreceived low molecular weight dextran. Her BP was114/92, and subsequently returned to 143/82. Herantihypertensive drug was restarted 5 days after symptomonset. Three days after treatment, she experienced nofurther episodes of visual disturbance or headache.Complete resolution of high-intensity areas was noted onrepeat MRI 1 month after treatment and the peripheralarterial constriction had resolved on repeat magneticresonance angiography. RPLS was diagnosed based on theimaging evidence and her complete recovery.

Author comment: "RPLS, in our case, was caused by thetoxic effects of ropivacaine, and hypotension may have beeninduced by the toxic effects of the drugs. The patient’s BPeasily returned to normal range as soon as administration ofropivacaine was stopped."Yamada SM, et al. A case of reversible posterior leukoencephalopathy syndromewith acute hypotension. Neurological Sciences 32: 165-8, No. 1, Feb 2011 -Japan 803056006

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Reactions 25 Jun 2011 No. 13570114-9954/10/1357-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved