Cushing Syndrome: A Potential Risk of Bilateral Postoperative Ischemic Optic Neuropathy after Lumbar Fusion.
Bumsoo ParkSeung-Won ChoiSanghyun HanJin-Young YoumJeong-Wook LimHyon-Jo KwonPublished in: Korean journal of neurotrauma (2019)
This is a report of a 58-year-old female with Cushing syndrome who underwent posterior lumbar fusion and lost both her vision completely. She was diagnosed with posterior ischemic optic neuropathy. Cushingoid features such as buffalo hump and central obesity might have attributed in triggering posterior ischemic optic neuropathy. When laid prone for surgery, perioperative high abdominal pressure causes venous hypertension leading to increase amount of blood loss. To compensate, infusion of large quantities of intravenous fluids is necessary which leads to hemodilution which decreases ocular perfusion pressure. Hypercoagulability of Cushing syndrome is also potentially a risk factor of this condition which increases the incidence of venous thromboembolism. For there is no known effective treatment for posterior ischemic optic neuropathy, means to prevent this complication must be strategically reviewed. When performing long spine surgery on patient who has Cushing syndrome or cushingoid features, caution must be taken to avoid this devastating complication.
Keyphrases
- case report
- minimally invasive
- venous thromboembolism
- risk factors
- ischemia reperfusion injury
- patients undergoing
- cerebral ischemia
- metabolic syndrome
- type diabetes
- insulin resistance
- magnetic resonance imaging
- weight loss
- coronary artery disease
- oxidative stress
- physical activity
- magnetic resonance
- body mass index
- climate change
- combination therapy
- percutaneous coronary intervention
- acute kidney injury
- subarachnoid hemorrhage