Posterior reversible encephalopathy syndrome in postpartum woman: a case report

Abstract

Posterior reversible encephalopathy syndrome (PRES) also known as reversible posterior leukoencephalopathy syndrome (RPLS) is a neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. PRES has been accompanied by a number of medical conditions such as hypertensive encephalopathy, preeclampsia, eclampsia, acute or chronic renal diseases, hemolytic uremic syndrome, use of cytotoxic and immunosuppressant drugs, blood transfusion, and electrolyte disturbances1. Clinical and radiological features of PRES include headache, encephalopathy, seizures, cortical visual changes, and parieto-occipital white matter edema visualized on neuroimaging modalities. An association between eclampsia and PRES was first described by Hinchey et al in 19962. Low magnesium levels can augment PRES(3). The diagnosis is typically made clinically, with supportive findings on magnetic resonance imaging of the brain. The treatment of PRES depends on the underlying cause. Prompt recognition and treatment are crucial to avoid the permanent damage leading to sequelae and even mortality. Many cases resolve within 1–2 weeks of controlling the blood pressure and eliminating the inciting factor. PRES may recur in about 5-10% of cases3. In this case report, we present a pre-eclamptic pregnant woman presented with acute loss of vision and elevated blood pleasure due to PRES without seizures after delivery (which is an uncommon complication of preeclampsia.)