Cushing Syndrome: A Potential Risk of Bilateral Postoperative Ischemic Optic Neuropathy after Lumbar Fusion
10.13004/kjnt.2019.15.e39
- Author:
Bumsoo PARK
1
;
Seung Won CHOI
;
Sanghyun HAN
;
Jin Young YOUM
;
Jeong Wook LIM
;
Hyon Jo KWON
Author Information
1. Department of Neurosurgery, College of Medicine, Chungnam National University, Daejeon, Korea. swchoi@cnu.ac.kr
- Publication Type:Case Report
- Keywords:
Spinal fusion;
Cushing syndrome;
Posterior ischemic optic neuropathy;
Intraocular pressure
- MeSH:
Buffaloes;
Cushing Syndrome;
Female;
Hemodilution;
Humans;
Hypertension;
Incidence;
Intraocular Pressure;
Middle Aged;
Obesity, Abdominal;
Optic Neuropathy, Ischemic;
Perfusion;
Risk Factors;
Spinal Fusion;
Spine;
Thrombophilia;
Venous Thromboembolism
- From:Korean Journal of Neurotrauma
2019;15(2):221-226
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
