Two Different Neuroimaging Patterns in Two Cases with Eclampsia, HELLP syndrome and Posterior Reversible Encephalopathy Syndrome

Abstract

Introduction: Preeclampsia (PE) and eclampsia are two clinical conditions associated with pregnancy. In eclampsia, seizures also occur. One of the complications of eclampsia is HELLP syndrome, a condition characterized by hemolytic anemia, elevated liver enzymes and thrombocytopenia. Preeclampsia and eclampsia are both well-known risk factors for posterior reversible encephalopathy syndrome (PRES), a clinical-radiological syndrome characterized by variable combinations of neurological signs. In this syndrome, typical neuroimaging findings are bilateral symmetric hemispheric edema in parietooccipital regions. However, atypical imaging findings have also been described. Here, we report two different neuroimaging patterns in two cases with PRES associated with eclampsia and HELLP syndrome. Case: Two pregnant female patients were admitted to our emergency department because of respiratory and neurological symptoms. While the medical history of one of the patients was unremarkable, the other patient was diagnosed with epilepsy and hypertension before pregnancy. Both of them had resistant increased blood pressure and seizures. They underwent urgent caesarean section. In the postoperative period, they were transferred into intensive care unit, necessitating mechanical ventilation because of respiratory failure. Laboratory findings were suggestive of eclampsia and HELLP syndrome and brain imaging findings were suggestive of PRES. Additionally, brain computed tomography scan of one of the patients showed subarachnoid haemorrhage and the magnetic resonance imaging scans of the other patient showed restricted diffusion, indicating cytotoxic edema. The patients were treated with blood transfusions and antihypertensive drugs. Maintenance of normotension resulted in neurological improvement. Subsequently, both of the patients were discharged without neurological sequela. Discussion and Conclusion: In this article, we reported both the associations between HELLP syndrome, eclampsia and PRES, and two different neuroimaging patterns of PRES. Effective controlling of blood pressure and treatment of HELLP syndrome resulted in complete disappearance of the radiological findings and improvement in the neurological sings.