Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological entity caused by reversible ischemia most commonly of the posterior cerebral vasculature. Diagnosis ofPRES might be obscured when the patient presents with visual anasognosia (Anton syndrome) as the initial manifestation. Case report: An 18 year old lady presented with vomiting, severe headache and oedema at 32 weeks gestation. She had severe-preeclampsia evidenced by blood pressure of 160/110mmHg, hyperreflexia and albuminuria. She further had visual anasognosia (cortical blindness) and a post-partum convulsion prompting the consideration of PRES, which was later confirmed by Magnetic Resonance imaging. She underwent immediate delivery by caesarean section followed by rapid reduction of blood pressure resulting in complete recovery within 48 hours. Conclusion: Prompt recognition of Posterior Reversible Encephalopathy Syndrome (PRES), which has a strong association with pre-eclampsia, is extremely important to prevent the associated morbidity and mortality. Eventhough, the vigilant management of PRES during ante-partum period might be complicated, this case consolidates the fact that early diagnosis of PRES leads to a favourable outcome. DOI: http://dx.doi.org/10.4038/slja.v23i1.7636
Highlights
Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological entity caused by reversible ischemia most commonly of the posterior cerebral vasculature
Prompt recognition of Posterior Reversible Encephalopathy Syndrome (PRES), which has a strong association with pre-eclampsia, is extremely important to prevent the associated morbidity and mortality
Eventhough, the vigilant management of PRES during ante-partum period might be complicated, this case consolidates the fact that early diagnosis of PRES leads to a favourable outcome
Summary
Posterior Reversible Encephalopathy Syndrome (PRES) is most commonly reported in association with preeclampsia and eclampsia.[1]. After 4 hours, she was admitted to the intensive care unit for further management as her blood pressure gradually rose to 200/130mmHg despite being on intravenous anti-hypertensives She never had fever or seizures during the antepartum period, or a significant past medical history such as epilepsy, hypertension or connective tissue disorders. Magnetic resonant imaging of the brain showed ill-defined areas of low signal intensity in T1- weighted images and abnormal high signal intensity in T2- weighted lesions distributed asymmetrically in the cerebral hemisphere bilaterally and left side of the brain stem These findings were compatible with the clinical diagnosis of Posterior Reversible Encephalopathy Syndrome. She was discharged on oral nifedipine on the sixth postpartum day
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