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Anaesthetic management of large meningioma excision complicated by Takotsubo and posterior reversible encephalopathy
  1. Sérgio Santos,
  2. Mafalda Castro,
  3. Ana Raimundo and
  4. Ana Ribeiro
  1. Anesthesiology, Coimbra EPE Hospital and University Center, Coimbra, Portugal, Coimbra, Portugal
  1. Correspondence to Dr Sérgio Santos; sdes87{at}


A 47-year-old woman with a history of a pulsatile headache, photophobia, dizziness and blurred vision was diagnosed with a massive expansive meningioma and proposed for surgical excision. During surgery, the patient began to show progressive haemodynamic instability with extreme hypotension and severe arrhythmia that only responded to epinephrine. With the continuity of haemodynamic instability, ST segment elevation and great amount of blood loss, the surgery was postponed. The follow-up brain CT scan showed evidence of posterior reversible encephalopathy syndrome and cardiac catheterisation diagnosed as Takotsubo syndrome. The patient remained sedated under aminergic support and was admitted to a cardiac intensive care unit. After clinic stabilisation, the patient underwent two more surgical procedures with special attention paid to monitoring haemodynamic stability, blood loss and cardiac output. After 70 days of admission, the patient was discharged with moderate visual impairment and follow-up consultations in neurosurgery and cardiology.

  • anaesthesia
  • neuroanaesthesia
  • haematology (incl blood transfusion)
  • heart failure

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  • Contributors SS, MC, ARa and ARi have participated in the evaluation and management of the case. SS and MC were responsible for scientific review. SS and ARa composed the manuscript. ARa and ARi were responsible for final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.