Abstract
Background: Posterior reversible encephalopathy syndrome (PRES) is a reversible syndrome characterized by seizures, headache, altered mentation, and loss of vision associated with white matter changes on imaging. Case: A 37-year-old multigravida woman had a severe, immediate postpartum eclampsia-HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) with PRES characterized by generalized seizures and altered mental status. Magnetic resonance brain imaging showed high-intensity lesions in non-posterior portions including the frontal lobe and cingulated gyrus, which resolved completely after 2 weeks along with complete symptom regression. Conclusions: Cases of postpartum PRES without involvement of posterior brain regions after eclampsia-HELLP syndrome are very rare. Patients with PRES do not always show typical manifestations. The importance of a prompt diagnosis is emphasized, as is the crucial role of rapid blood pressure reduction.
Highlights
Posterior reversible encephalopathy syndrome (PRES) has a unique neuroradiological finding of vasogenic edema in the brain and clinical symptoms including headache, altered mental function, seizure, and visual disturbance [1]-[4]
HELLP syndrome is a pregnancy-related disorder that is regarded as being a variant of eclampsia
We describe an atypical case of PRES involving non-posterior portions immediate postpartum eclampsia-HELLP syndrome
Summary
Posterior reversible encephalopathy syndrome (PRES) has a unique neuroradiological finding of vasogenic edema in the brain and clinical symptoms including headache, altered mental function, seizure, and visual disturbance [1]-[4]. Edema is predominant in the posterior portions of the white matter. (2016) A Typical Case of Posterior Reversible Encephalopathy Syndrome Associated with Postpartum Eclampsia-HELLP Syndrome. For pregnant and immediate postpartum women, (pre-)eclampsia is an important cause of PRES [9]-[12]. HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) is a pregnancy-related disorder that is regarded as being a variant of eclampsia. Isolated reports of PRES associated with HELLP syndrome have been published so far [13]-[16]. We describe an atypical case of PRES involving non-posterior portions (the frontal lobe and cingulated gyrus) immediate postpartum eclampsia-HELLP syndrome
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