A case of subdural block triggered posterior reversible encephalopathy syndrome: A case report

Posterior reversible encephalopathy syndrome (PRES) is a relatively rare neurological disorder in obstetrics. Clinically, the most common precipitating factors are hypertension, immunosuppressive agents, or chemotherapy drugs. It is extremely rare for PRES to be induced by the entry of local anesthetic into the subdural space. In this case report, we present an instance where a patient experienced blurred vision, and even blindness, following an accidental subdural block administered by the anesthetist, and was subsequently diagnosed with PRES. The patient was a 30-year-old parturient who developed blurred vision and headache after surgery, which further progressed to blindness. Based on the clinical manifestations of headache, blurred vision, and even blindness in the patient, in conjunction with the imaging findings of abnormal signals in the bilateral temporal, parietal, and occipital lobes of the brain as well as the cerebellar hemispheres, a diagnosis of PRES was made. Fluid restriction, diuresis, antihypertensive treatment, and neurotrophic support. The patient's headache symptoms were rapidly alleviated, and her vision gradually returned to normal, leading to a successful recovery and discharge from the hospital. This is an extremely unusual case. The accidental subdural block affected the vasoconstriction of the cerebral blood vessels, which induced PRES. Given that postoperative headaches in obstetric patients are often attributed to postdural puncture headache, the initial misdiagnosis and mistreatment by the obstetrician nearly led to a severely adverse prognosis for the patient.