Posterior reversible encephalopathy syndrome after postpartum hemorrhage and uterine artery embolization

Abstract

Rationale:Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical and radiological features, including headache, disturbed consciousness, seizures, and cortical blindness associated with findings indicating posterior leukoencephalopathy on imaging studies. Ours is the first case of PRES developing after postpartum hemorrhage and uterine artery embolization.Patient concerns:An 18-year-old patient had postpartum hemorrhage after a normal delivery. She required uterine artery embolization to stop the bleeding; however, she developed PRES 2 hours after the surgery.Diagnoses:Brain computed tomography suggested subarachnoid hemorrhage or cerebral venous sinus thrombosis. However, findings on magnetic resonance imaging were highly indicative of PRES.Interventions:The patient received diazepam and midazolam to prevent seizures.Outcomes:Seizures were controlled on the first day. The patient's visual acuity returned to normal on the fourth day of admission. Thirteen days after admission, her neurological signs and symptoms were completely managed.Lessons:PRES may be related to postpartum hemorrhage, blood pressure fluctuation, inflammation, and contrast agents. Collectively, they cause a breakage in the blood–brain barrier and endothelial cell damage, eventually leading to PRES. We also found PRES had many features similar with contrast-induced encephalopathy.

Posterior Reversible Encephalopathy Syndrome after Hypovolemic Shock Which Is Required Differential Diagnosis with Delirium in the Intensive Care Unit

“…Also other vasogenic edematous encephalopathies, especially contrast-induced encephalopathy, should be considered. Contrast used during angiography or embolization could induce the vasogenic encephalopathy because of the disruption of blood-brain barrier [6]. However, the onset of encephalopathy was delayed from the usage of contrast and diffusion-weighted imaging in MRI (Figure 2B) showed no pathologic lesions in this patient, so we diagnosed as PRES.…”

Hidden Moyamoya Disease Mimicking Reversible Cerebral Vasoconstriction Syndrome

“…Although an elevated postpartum blood pressure as seen in preeclampsia or eclampsia is a well-known clinical finding associated with .the development of PLS, a normal delivery might feature it as well. 5 Besides, there have been no reported cases of concomitant PLS and MMD to date in the literature.…”

Clinical Discussion on Contrast-induced Encephalopathy with Clinical Manifestation of Cerebral Hemorrhage

“…Patients show cerebral hemorrhage in clinic, and the main s include headache, blurred vision, nausea and vomiting. Thus, it is required to focus on prevention of CIE for the above patients [7][8][9].…”