Postoperative complete amaurosis fugax in severe pre-eclampsia: a case report

Abstract

Introduction One of the complications of severe preeclampsia is cortical blindness which could be reversible or permanent. It is the most disturbing symptom of reversible post encephalopathy syndrome in preeclampsia and eclampsia. Case Discription An 18-year-old primigravida was admitted with term pregnancy in the obstetrics department, having high arterial blood pressure with pitting edema with proteinuria, hematuria, impaired renal functions, and elevated serum transaminases. She was treated with 250 mg of methyldopa three times a day, but as hypertension persisted, the patient was admitted to ICU and was given labetolol 200 mg three times a day orally, along with oxygen by mask. Sonographic examination showed cord around the neck with an arterial blood pressure of 160/110 mmHg. Cesarean section was planned. The patient was given 500 mg of methyldopa and labetalol 200 mg orally in the morning, few hours before being taken to the operating room. Segmental epidural block with 12 ml of 0.5% ropivacaine was performed, with epidural catheter left in situ in the L2-3 space and top up dose of same 6ml drug is given later on. Lower segment cesarean section was performed and the baby was delivered with an APGAR score of 8. On the second postoperative day, she developed headache, giddiness, and blurred vision, which became progressive. Computed tomography and MRI reports confirmed posterior reversible encephalopathy syndrome. She was treated accordingly and early management helped her recover completely. Conclusion This case report emphasizes the need for early diagnosis and prompt treatment of PRES to avert short-term and long-term neurological sequelae. Early treatment usually results in complete reversal of deficits over few days to few weeks.