A Typical Case of Posterior Reversible Encephalopathy Syndrome Associated with Postpartum Eclampsia-HELLP Syndrome

Abstract

Posterior reversible encephalopathy (PRES) is a rare clinical entity which presents with neurological signs and symptoms with characteristic findings on neuroimaging. Eclampsia is a common pre-disposing cause. We report a case of a 29-year-old lady presenting at 36 weeks of gestation with eclampsia evident by a very high blood pressure, generalized tonic clonic (GTC) seizures, albuminuria and clonus. She remained drowsy with a fluctuating Glasgow coma scale (GCS) post-delivery with features of HELLP syndrome, prompting the need for neuroimaging which confirmed PRES. Early normal vaginal delivery (NVD), with aggressive blood pressure and seizure control resulted in a complete recovery within 72 hours post-partum. In a pregnant patient with eclamptic seizures, a high degree of suspicion is needed, and neuroimaging should be utilized in order to diagnose PRES. This case highlights the fact that PRES is a reversible entity with favourable outcomes with timely recognition and aggressive management.

Postpartum HELLP syndrome associated with posterior reversible encephalopathy syndrome: a case report and literature review

“…Consequently, this autoregulation affords better protection against damaging hypertension to the anterior than the posterior circulation. However, the protective sympathetic mechanism of the anterior circulation also may be overcome in severe cases and the brain stem, basal ganglia, frontal and temporal lobes, and cerebellum may also be involved [7], [8], [10], [13]- [16], [18], [19], [21]- [23]. In our case, the involvement of the left occipital lobe, both hemispheres of parietal and frontal lobes bilaterally, and the cerebellum bilaterally indicates a severe disturbance in cerebral autoregulation.…”

“…PRES is not always reversible though the name suggests, and its outcome is variable. Prompt diagnosis and properly treatment can lead to complete reversal of clinical and neuro-radiological findings with favorable outcomes [7]- [23]. However, in a few patients, it bears a risk of permanent cerebral damage if therapy is delayed [6].…”

“…These terms were further combined with "HELLP". We found only 17 records describing this combination, occurring during pregnancy in 10 papers [7]- [16] (Table 1) and in the post-partum in the other 7 [17]- [23] (Table 2).…”