Posterieur reversibel encefalopathiesyndroom in het postpartum

Abstract

A late postpartum complication The posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome characterized by acute neurological symptoms such as headaches, visual symptoms, altered consciousness and epileptic seizures in combination with subcortical vascular edema. One of the possible causes of PRES is pre-eclampsia. Observational studies show that some women with new-onset hypertension in the postpartum have an imbalance in pro- and anti-angiogenic factors, as in women with antepartum pre-eclampsia. Based on this case report, this potentially dangerous clinical entity is described. The 38-year-old primiparous patient presented 17 days after childbirth with a headache and severe hypertension. The diagnosis of PRES was made via an MRI. There was a good clinical response among chlorthalidone, bisoprolol and amlodipine. Sequential MRI images showed reversibility of the lesions. Regular blood pressure monitoring in women who recently gave birth, is important. New-onset hypertension is an alarm sign for pre-eclampsia in this patient group. Brain imaging is strongly recommended in case of the concomitant presence of risk factors of a headache. Early diagnosis of PRES and rapid treatment are necessary to prevent permanent neurological damage and mortality.