Posterior reversible encephalopathy syndrome in preeclampsia

Abstract

Background: Posterior reversible encephalopathy is a clinico-radiological syndrome marked by headache, altered mental status, seizures, visual disturbances, and extensive white-matter changes, also known as hyper perfusion encephalopathy, brain capillary leak syndrome, and hypertensive encephalopathy. This syndrome was a possible consequence of several medical conditions but especially in pregnancy it is associated with pre-eclampsia and eclampsia. Objective of this study was to know the incidence and analyze the clinical features, biochemical, and radiological abnormalities in posterior reversible encephalopathy syndrome (PRES) as a complication of preeclampsia.Methods: This was a one-year cross-sectional analytical study conducted at NRI general hospital, Chinakakani, Guntur of patients with the diagnosis of PRES. Data was obtained from medical records and analyzed them in terms of mean for continuous variables and percentages for categorical data.Results: Total no of patients diagnosed as PRES were 16 out of 127 patients of preeclampsia. Among them, 14 presented with eclampsia, and two presented with severe preeclampsia and imminent symptoms of eclampsia. Headache was the most common symptom (100%). PRES occurred at a peak SBP of ≥160 mmHg in 75% cases and peak DBP of ≥110 mmHg in 50% cases. Serum lactate dehydrogenase (LDH) level was ≥600 in 56.25% and serum uric acid level ≥6 in 50% of patients of PRES. The drug of choice was magnesium sulfate.Conclusions: Neuroimaging abnormality is a definitive component in the diagnosis of PRES. These cerebral abnormalities are vital components in the pathogenesis of eclampsia. Considerable number of patients of preeclampsia might develop PRES even without eclampsia, with mild elevation in BP, serum LDH, and serum uric acid levels.

General Anesthesia for the Gravid Patient in the Emergency Operating Room at Sanglah General Hospital

“…About 1-5% of cases of chronic hypertension occur in all pregnancies worldwide. Superimposed preeclampsia is defined as chronic hypertension that occurs in pregnant women with gestational age > 20 weeks with manifestations of preeclampsia such as thrombocytopenia, impaired liver function, renal insufficiency or other manifestations of preeclampsia [2]. Superimposed preeclampsia carries a higher risk of morbidity and mortality compared to chronic hypertension alone [3].…”

“…Superimposed preeclampsia carries a higher risk of morbidity and mortality compared to chronic hypertension alone [3]. When seizures are present, the condition is referred as eclampsia [2].…”

“…The main treatment for superiomposed preeclampsia is termination of pregnancy, with fetal maturity and maternal morbidity taken into consideration. Vaginal delivery is still the method of choice for delivery, but if neurological symptoms (such as decreased level of consciousness, seizures, blurred vision, severe headache, nausea and vomiting accompanied by intracerebral bleeding, pulmonary edema, and proteinuria > 4-5 grams/day) are present, vaginal delivery cannot be done [2,4]. Neurological symptoms that arise in preeclampsia are associated with the presence of encephalopathy posterior syndrome, which can be caused by failure of autoregulation, blood-brain barrier leakage, and influx of serum protein to the brain tissue [5].…”