Posterior Reversible Encephalopathy Syndrome: Is There a Difference between Pregnant and Non-Pregnant Patients?

Roth, Christian; Ferbert, A.

doi:10.1159/000226430

Cited by 52 publications

(52 citation statements)

References 41 publications

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“…Diffusionweighted imaging may show an increased signal in the occipital lobes and in corresponding apparent diffusion coefficient maps consistent with vasogenic rather than cytotoxic edema. This appearance is consistent with that of PRES (posterior reversible encephalopathy syndrome) (67,68).…”

Section: Pregnancy-specific Neuro-ophthalmologic Conditions: Severe Psupporting

confidence: 85%

Neuro-Ophthalmology and Pregnancy

Digre

2011

Journal of Neuro-Ophthalmology

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Management of the pregnant woman with a neuro-ophthalmic disorder may be challenging. Physiologic changes in pregnancy make vascular conditions more frequent, including retinal artery occlusion, spontaneous orbital hemorrhage, and pituitary apoplexy. Papilledema may signal cerebral venous sinus thrombosis or idiopathic intracranial hypertension. Manifestations of severe preeclampsia and eclampsia include choroidal infarction, serous retinal detachment, and disorders of higher cortical function, such as alexia, simultanagnosia, and cerebral blindness. Cranial neuropathies have also been reported. Transient Horner syndrome, intracranial hypotension with comitant esotropia may occur in the postpartum period. Treatment of the neuro-ophthalmic complications of pregnancy requires an understanding of the risks of medications. Taking optimal care of the mother will usually result in the best care for her baby.

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Section: Pregnancy-specific Neuro-ophthalmologic Conditions: Severe Psupporting

confidence: 85%

Neuro-Ophthalmology and Pregnancy

Digre

2011

Journal of Neuro-Ophthalmology

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“…3,4 Tonic-clonic seizures are not mandatory for the diagnosis of PRES and pre-eclamptic women may demonstrate signs, symptoms and imaging features of PRES in the absence of an eclamptic seizure. [5][6][7] The incidence and possible sequelae of PRES in women with pre-eclampsia are unknown, because cerebral imaging in such women is not standard practice. Whether long-term cerebrovascular outcome, such as stroke, in formerly pre-eclamptic women is a result of the constitutionally increased risk for cardiovascular disease ª 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2012 RCOG in these women, 1,2 or whether the pre-eclamptic pregnancy and episode of PRES are additional risk factors, remains speculative so far.…”

Section: Introductionmentioning

confidence: 99%

Long‐term cerebral imaging after pre‐eclampsia

Aukes

Groot

Wiegman

et al. 2012

BJOG

109

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Objective Formerly eclamptic women demonstrate cerebral white matter lesions (WMLs) several years following the index pregnancy. The pathophysiology is unclear and may be related to the predisposition for cerebrovascular/cardiovascular disease in such women and/or the occurrence of posterior reversible encephalopathy syndrome whilst pregnant. The aim of this study was to assess the presence and severity of WMLs and their relationship with the severity of the neurological symptoms during the index pregnancy and several current cardiovascular risk factors in formerly pre-eclamptic women.Design This was a retrospective cohort study.Setting The Neuroimaging Centre at the School for Behavioural and Cognitive Neurosciences, Groningen, the Netherlands.Population Seventy-three formerly pre-eclamptic women were matched for age (37 ± 6 years) and elapsed time since index pregnancy (5.1 ± 3.7 years) with parous control women.Methods Cerebral magnetic resonance imaging scans were performed on cases and controls. Scans were rated by a neuroradiologist blind to the patient category.Main outcome measures The presence and severity of cerebral WMLs.Results Formerly pre-eclamptic women had WMLs significantly more often (37%) and more severely (mean, 0.11; median, 0.00; range, 0-2.34 ml) than controls (21%, P = 0.04; mean, 0.015; median, 0.00; range, 0-0.13 ml; P = 0.02). Current hypertension and a history of early-onset pre-eclampsia (<37 weeks) were independently associated with the presence of WMLs (b = 1.34, P = 0.02 and b = 1.73, P = 0.01, respectively).Conclusions Our findings indicate that pre-eclampsia might be a risk marker for early cerebrovascular damage. The predisposition of formerly pre-eclamptic women to later cardiovascular and cerebrovascular disease may be an important factor for the development of cerebral WMLs. Whether a history of posterior reversible encephalopathy syndrome may be an additive risk factor for the development of these lesions remains unknown.

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“…Therefore this case is important as it illustrates atypical symptoms in PRES and also emphasizes the importance of cranial MRI in preeclamptic patients with neurological signs and symptoms. Most authors believe that hypertensive encephalopathy and eclampsia share similar pathophysiologic mechanisms (17)(18)(19). The imaging findings and clinical features of postpartum eclampsia are identical to those of hypertensive encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

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

Aygün¹,

Baykuş²,

Berilgen³

et al. 2010

J Turkish German Gynecol Assoc

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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.

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Posterior Reversible Encephalopathy Syndrome: Is There a Difference between Pregnant and Non-Pregnant Patients?

Cited by 52 publications

References 41 publications

Neuro-Ophthalmology and Pregnancy

Neuro-Ophthalmology and Pregnancy

Long‐term cerebral imaging after pre‐eclampsia

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

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