Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients

Abstract

Posterior reversible encephalopathy syndrome (PRES) is an obstetric emergency frequently occurring in a pregnant or puerperal woman, manifested with an acute headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem and basal ganglia. Since magnetic resonance imaging (MRI) is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image.

Isolated pontine involvement in posterior reversible encephalopathy syndrome with coincidental acute ischaemic stroke

“…According to the first hypothesis, which is widely accepted, the vascular leakage and vasogenic oedema is caused by elevation of blood pressure above the cerebral autoregulation. The second theory suggests that this syndrome is triggered by endothelial dysfunction caused by circulating either endogenous (as seen in pre-eclampsia and sepsis) or exogenic (such as chemotherapy and immunosuppressive agents) toxins 5. The predominantly posterior distribution can be explained on the grounds of better developed sympathetic innervations and autoregulation in the anterior circulation 6…”

Reversible splenial lesion syndrome associated with lobar pneumonia

“…The typical features of PRES on MRI commonly appear as hyperintensity on T2WI and FLAIR images in the parieto-occipital and frontal cortical and subcortical white matter. [54] Infarction of corpus callosum is occasionally seen. Common lesions of callosal infarction are localized on the knee and body of corpus callosum.…”

Postpartum Atypical Posterior Reversible Encephalopathy Syndrome in a COVID-19 Patient – An Obstetric Emergency

“…Presence of hemorrhage, diffusion restriction and contrast enhancement with symmetrical or asymmetrical posterior predominant vasogenic edema constitute atypical PRES, these findings are known to be uncommon in postpartum PRES. 4,5 While there are several reports of PRES with COVID-19, the atypical variant has only been rarely reported and none in pregnancy. 6 To our knowledge this is the first case report on postpartum atypical PRES with COVID-19.…”