Posterior reversible encephalopathy syndrome at term pregnancy with eclampsia

Abstract

The incidence of eclampsia in developed countries is 1 in 3000 and the incidence of posterior reversible encephalopathy syndrome (PRES) is 1 in 400 eclampsia patients. Not many cases of PRES have been reported from Tamil Nadu. This can be an eye opener for ophthalmologists if a patient comes with a sudden loss of vision. PRES is also known as reversible posterior leukoencephalopathy syndrome. It is a cliniconeuroradiological syndrome associated with various clinical conditions presenting with headache, seizures, and cortical visual disturbance. Imaging predominantly shows parieto-occipital white matter changes with vasogenic edema being the most accepted pathophysiology. We report a 25-year-old primigravida who presented in term pregnancy with pregnancy-induced hypertension, seizures, and blindness. Magnetic resonance imaging showed subcortical signal abnormalities in the occipital lobes, which is a sign of PRES. She was managed by controlling her blood pressure levels, and emergency cesarean section was done. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment.