Posterior Reversible Encephalopathy Syndrome in severe preeclampsia: case report and literature review

Abstract

ÖzetWe describe a 23 year old primigravid patient with severe preeclampsia complicated by posterior reversible encephalopathy syndrome (PRES), who presented with sensory and motor deficits and amnesia in the postpartum period Cranial magnetic resonance imaging (MRI) showed abnormal areas in the white matter of bilateral parieto-occipital lobes, indicating brain edema which disappeared completely on the follow-up scan taken four weeks after delivery together with complete symptom regression. The development of PRES in preeclampsia is discussed and the importance of prompt postpartum blood pressure control is emphasized.(J Turkish-German Gynecol Assoc 2010; 11: 216-9) Bu yazıda 23 yaşında, ilk gebeliği olan şiddetli preeklamptik bir hastada postpartum dönemde duyusal ve motor sinir bulguları ve unutkanlık ile ortaya çıkan bir posterior reverzibl ensefalopati sendromu (PRES) sunulmuştur. Kranyal manyetik rezonans görüntüleme (MRI) ile bilateral parieto-occipital loblarda beyin ödemine işaret eden anormal alanlar görülmüş olup, doğumdan dört hafta sonra kontrol amaçlı yapılan görüntüleme testi ile bu lezyonların tamamen kaybolduğu ve semptomların da gerilediği tespit edilmiştir. Preeklampside PRES gelişimi tartışılarak, bu hastalarda postpartum kan basıncı kontrolünün önemi vurgulanmıştır.

Preeclampsia history and postpartum risk of cerebrovascular disease and cognitive impairment: Potential mechanisms

“…In the postpartum period, white matter lesions tend to occur predominantly in the frontal lobe compared to any other brain region following (pre)eclampsia (Postma et al, 2014). During pregnancy, however, neurological findings in (pre)eclampsia patients occur mostly in the posterior cortical or subcortical region (Sharshar et al, 1995) including the parietal-occipital lobe (Topuz et al, 2008;Aygün et al, 2010;Mitas and Rogulski, 2012) (Figure 1). While not as frequent, anterior/frontal lobe abnormalities have also been reported in (pre)eclampsia patients during pregnancy (Riskin-Mashiah and Belfort, 2005).…”

Magnesium Sulfate Prevents Placental Ischemia-Induced Increases in Brain Water Content and Cerebrospinal Fluid Cytokines in Pregnant Rats

“…The findings of blood-brain barrier (BBB) disruption and cerebral edema formation using various imaging modalities, such as MRI and CT scans (Apollon et al, 2000; Demirtaş et al, 2005; Aygün et al, 2010) demonstrate that the cerebral vasculature is affected in preeclampsia patients. Further evidence of BBB disruption has been provided using an isolated vessel preparation that showed that plasma from preeclampsia patients increases cerebral venous permeability (Amburgey et al, 2010; Schreurs and Cipolla, 2013; Schreurs et al, 2013).…”

A global amnesia associated with the specific variant of posterior reversible encephalopathy syndrome (PRES) that developed due to severe preeclampsia and malignant hypertension

“…Certain conditions such as malignant hypertension and eclampsia, among others, are reported as the potential causes of PRES, while the pathophysiological mechanisms implicated are a breakthrough of vascular autoregulation and endothelial dysfunction [ 4 ]. Only a few sporadic reports in the literature exist that bring amnesia or amnesia-like symptomatology into association with PRES [ 5 , 6 ]. However, a dramatic memory deficit that included both anterograde and retrograde memory processing, as implicated in our case, has not been previously elaborated.…”