Eclampsia and posterior reversible encephalopathy syndrome (PRES): A retrospective review of risk factors and outcomes

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity initially described in 1996. PRES frequently develops in patients with preeclampsia and eclampsia. There is not much literature on risk factors causing PRES in pregnant patients with eclampsia. This study aimed to determine the incidence of PRES in eclampsia, its association with pregnancy, risk factors, and maternal and perinatal outcomes. Patients and methods: All patients who were admitted with eclampsia and developed PRES in an intensive care unit of a tertiary medical facility between 1997 and 2017 were included in the study. Patients’ demographics, pregnancy and gestational data, treatment mode, and outcomes were retrospectively obtained from their medical charts/files. Data were entered using SPSS program version 23. Chi-square test was used to compare the variables, and a p value of < 0.05 was considered statistically significant. Results: A total of 151 patients were admitted during the study period, and 25 developed PRES. The diagnosis was common in patients older than 25 years. Eclampsia patients who developed PRES were without any pregnancy-associated comorbidities (p < 0.08). At the time of diagnosis, their gestational age was more than 36 weeks, which was significant (p < 0.04). Incidence was significantly higher in patients presenting with eclampsia and had recurrent seizures (p < 0.01 and 0.002, respectively). Its incidence was significantly higher in postpartum eclampsia patients (p < 0.01). It was also significantly higher in patients who had cesarean section and hypertension treated with labetalol (p < 0.001 and 0.02, respectively). Overall, the maternal mortality rate of eclampsia patients complicated with PRES was 4% in our population. Conclusion: Of eclampsia patients, 16% developed PRES, which is on the lower side than the reviewed literature (10%–90%). Eclampsia on presentation, recurrent seizures, postpartum eclampsia, cesarean delivery, and labetalol use were associated with increased risk of PRES development.

Eclampsia-Associated Posterior Reversible Encephalopathy Syndrome (PRES) Complicated by Intracerebral Hemorrhage: A Case Report and Review of Management Strategies

“…Severe cases may lead to seizure activity, status epilepticus, and coma, and although PRES is reversible, if not managed immediately, it can lead to irreversible parenchymal injury and physical or mental disabilities [ 6 ]. The risk of developing severe PRES is increased in postpartum eclampsia, recurrent seizure activity, cesarean delivery, and labetalol use [ 13 ]. In this case, the patient had a history of PE/E treated with labetalol, recurrent seizure activity, and a cesarean delivery, which increased her risk of PRES with severe features.…”

Atypical Presentation of Antenatal Eclampsia

“…PRES is the most common neuroimaging finding in eclampsia. The co-incidence can be as high as 90-98% [ 11 , 12 ].…”

Pharmacological Management of Arterial Hypertension and Clinical Outcome of a Retrospective Cohort of Patients with Eclampsia

“…Blood pressure control improves the maternal condition for pregnancy termination (vaginal, cesarean section) because it reduces the possibility of hypertensive complications of the heart, lungs, kidneys, liver, coagulation mechanism and placenta. It also decreases the risk of serious brain injuries such as the severe edema that characterizes PRES, cerebral hemorrhage, the onset or recurrence of seizures due to eclampsia, and long-term sequelae [8,[16][17][18].…”

“…For this reason, it cannot be established whether uncontrolled arterial hypertension generated the seizures and then the lesions or whether the lesions were generated first and then the seizures. Fortunately, at the end of the study, no cases of maternal death occurred, but there is the possibility of serious long-term sequelae as described in the literature [8,[16][17][18].…”

“…In this regard, in 2005 Martin et al [6] studied the relationship between cerebral hemorrhage and increased SBP in 28 patients with eclampsia and found greater probabilities of neurological complications when SBP was between 155 and 160 mmHg. Based on all these antecedents, it has been insisted that the pharmacological control of arterial hypertension in patients with SP is absolutely necessary to prevent progression to eclampsia and other widely known serious cerebral complications such as extensive edema, parenchymal hemorrhage, intracranial hypertension, posterior reversible encephalopathy syndrome (PRES) and long-term sequelae [5,8].…”