Headache and Status Epilepticus in the Postpartum Period; Posterior Reversible Encephalopathy Syndrome or Cerebral Venous Thrombosis?

Panagiotis Zis,Antonios Tavernarakis

doi:10.1155/2013/680327

Abstract

We report a case of a young woman, with a history of a miscarriage and a molar pregnancy, who developed headache and status epilepticus in postpartum day three. Posterior reversible encephalopathy syndrome (PRES) and cerebral venous and sinus thrombosis (CVST) can present with identical clinical picture; however, the imaging findings can help the clinician to make the correct diagnosis and initiate the appropriate treatment. Both PRES and CVST are medical emergencies and fully reversible entities especially when treatment initiation is immediate.

Highlights

Acute neurological symptoms in the postpartum women could be caused by exacerbation of a preexisting neurological condition, by initial presentation of a non-pregnancy-related problem, or by new onset neurological conditions that occur uniquely or with increased frequency just after pregnancy [1].The clinician, either the obstetrician or the neurologist, based on the patient’s history and the postpartum course, should be able to identify and evaluate the presenting symptoms
The magnetic resonance imaging (MRI) at discharge showed that all lesions disappeared (Figure 4), and a diagnosis of posterior reversible encephalopathy syndrome was made
Posterior reversible encephalopathy syndrome (PRES) in the postpartum period is an infrequent diagnosis in day-today obstetric care [2]

Summary

Introduction

Acute neurological symptoms in the postpartum women could be caused by exacerbation of a preexisting neurological condition, by initial presentation of a non-pregnancy-related problem, or by new onset neurological conditions that occur uniquely or with increased frequency just after pregnancy [1]. We report a case of a gravida 1 para 3 who presented initially with headache and few hours later with status epilepticus, in the postpartum period. This case was challenging because of the puzzling imaging findings, medical history, and neurological signs, and as it was a fully treatable emergency situation that involved two distinct specialties: neurology and obstetrics. The patient complained of severe diffuse headache, dizziness, and vomiting, symptoms that were improving when lying and initially were attributed to intracranial hypotension caused by the epidural anesthesia. The MRI at discharge showed that all lesions disappeared (Figure 4), and a diagnosis of posterior reversible encephalopathy syndrome was made

Discussion

Conclusion