A Rare Case of Antepartum Posterior Reversible Encephalopathy Syndrome

Abstract

Pre-eclampsia and eclampsia are well-known causative factors of posterior reversible encephalopathy syndrome (PRES). There are only a few reported cases of antepartum PRES. We report a 25-year-old primigravid woman who presented with eight months of amenorrhoea and an abrupt onset of eclampsia associated with a history of a fall. A computed tomography scan ruled out intracranial haemorrhage and PRES was diagnosed. She responded well to supportive care, labour was induced and maternal and neonatal outcomes were good. Antepartum PRES poses different challenges to those of PRES in non-obstetric or postpartum patients, because of the additional management aspects required to ensure foetal wellbeing. We were posed with a difficult decision about the disadvantages of caesarean section versus those of vaginal delivery in our patient.

Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: case report

“…PRES syndrome has been associated with a variety of conditions. The main obstetric precipitating factor is preeclampsia-eclampsia [7] with cases of PRES having been observed both postpartum and antepartum [4,5,8,9]. Other associa-Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: case report tions highlighted in literature include retained placental fragments leading to delayed eclampsia [10], dural puncture/regional anesthesia [11], infection/sepsis with gram-positive organisms [12], molar pregnancy [9,13] and only one case of twin pregnancy [14].…”

“…A third mechanism suggested is that of endothelial dysfunction in cases of preeclampsia-eclampsia and sepsis, leading to vascular instability, vasoconstriction and hypoperfusion [18]. Early recognition of PRES is vital since reversibility of PRES is not spontaneous but depends on prompt management of hypertension and withdrawal of precipitating factors [4,7,16]. If treated adequately, symptoms typically resolve within seven days [5].…”

“…Diagnosis of PRES is based on the simultaneous presence of clinical features of acute neurologic compromise, brain neuroimaging findings, and clinical/radiologic proof of reversibility [3]. Despite the increasing number of reports indicating awareness of PRES among clinicians [4], its prevalence is still unknown [5,6].…”