Stroke with postoperative visual loss as the first clinical manifestation of antiphospholipid antibody syndrome: Case report

Postoperative visual loss (POVL) is a rare and devastating complication. Its incidence in nonophthamologic surgeries varies from 0.056 % to 1.3 %. Autoimmune rheumatic diseases with a predisposition to thrombotic events, such as antiphospholipid antibody syndrome (APS), may constitute an important r...

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Bibliographic Details
Published in:International journal of surgery case reports 2023-05, Vol.106, p.108231, Article 108231
Main Authors: Neto, Angelo Rossi, Mendonça, Fabricio Tavares, de Aviz, Marcus Alexandre Brito, Novas, Rodrigo Gomes Minas, Freitas, Ricardo Del Negro Barroso
Format: Article
Language:English
Subjects:
Anti-phospholipid syndrome
Blindness
Case Report
Embolic stroke
Intracranial embolism
Thrombosis
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Summary:Postoperative visual loss (POVL) is a rare and devastating complication. Its incidence in nonophthamologic surgeries varies from 0.056 % to 1.3 %. Autoimmune rheumatic diseases with a predisposition to thrombotic events, such as antiphospholipid antibody syndrome (APS), may constitute an important risk factor for this complication. A 34-year-old female patient, who was a former smoker and had no other comorbidities. She underwent orthopedic surgery and presented with bilateral POVL associated with the loss of secondary muscle strength and intraoperative venous and arterial cerebral thrombosis. She was thoroughly investigated regarding the etiology of her condition, and high levels of antiphospholipid antibodies were found. APS is an autoimmune disease that predisposes the patient to thrombotic events. Among these, stroke is one of the main causes of POVL secondary to ischemia of the cortical territory, or also known as “cortical blindness.” The rare incidence of POVL in nonophthalmological surgeries and the consequence and preservation in the literature on the subject, explain the limitations of its pathophysiology, and especially the development of guidelines focused on the prevention of patients with risk factors for this condition. Thus, this case report warns about the risks and anesthetic care that patients with risk factors should have when undergoing nonophthalmological surgeries. •Postoperative visual loss is a rare complication in non-ophthalmologic surgeries•Antiphospholipid syndrome is characterized by multiple organ thrombosis•Cortical blindness and stroke are the leading causes of postoperative visual loss
ISSN:2210-2612
2210-2612
DOI:10.1016/j.ijscr.2023.108231