Postpartum Atypical Posterior Reversible Encephalopathy Syndrome in a COVID-19 Patient – An Obstetric Emergency

Abstract

Encephalopathy in COVID-19 has been widely reported with several reports of posterior reversible encephalopathy syndrome (PRES) speculated to be due to an abrupt surge in blood pressure caused by coronavirus disease. Though peripartum posterior reversible encephalopathy syndrome is well recognized, its atypical variant with hemorrhage is uncommon. Peripartum atypical posterior reversible encephalopathy syndrome with COVID-19 requires early recognition and warrants dedicated inter-disciplinary management. We present a case of postpartum atypical posterior reversible encephalopathy syndrome with good maternal and fetal outcome. Our clinical and treatment approach with differential diagnosis are discussed in this hitherto unreported obstetric emergency with COVID-19.

Persistent visual dysfunction following posterior reversible encephalopathy syndrome due to COVID‐19: Case series and literature review

“…Database search recovered 37 unique articles describing PRES and COVID‐19, of which five were excluded after abstract review. The remaining 32 articles underwent full text review; 22 articles met all inclusion criteria and contained detailed clinical information on 32 individuals with PRES and COVID‐19 [6–27]. All cases reported MRI findings consistent with a diagnosis of PRES (Table 1).…”

“…The majority of cases of PRES occurred in the setting of critical COVID‐19 illness requiring mechanical ventilation or severe COVID‐19 requiring other forms of respiratory support (Figure 4a) [5]. Seven cases (20%) reported development of PRES with only mild or asymptomatic COVID‐19 (Figure 4a) [5,10,12–14,16,26,27]. Of these, three individuals were older than 65 years, with medical risk factors for COVID‐19 [1,10,12,16], and two were peripartum (Table 1) [13,26].…”

“…Seven cases (20%) reported development of PRES with only mild or asymptomatic COVID‐19 (Figure 4a) [5,10,12–14,16,26,27]. Of these, three individuals were older than 65 years, with medical risk factors for COVID‐19 [1,10,12,16], and two were peripartum (Table 1) [13,26]. BP was reported in nearly all cases and was often described as poorly controlled or fluctuating, but continuous monitoring information was difficult to glean from case descriptions.…”

“…BP was reported in nearly all cases and was often described as poorly controlled or fluctuating, but continuous monitoring information was difficult to glean from case descriptions. Notably, 10 cases (28%) reported systolic BP greater than 200 mmHg [10,21], diastolic BP greater than 100 mmHg [13,19,26], or mean arterial pressure greater than 100 mmHg [17,20,21].…”

The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review

“…The remaining 34 articles, including case reports, case series, letters to the editor, pictorial essays etc. reporting cases of PRES in COVID-19 were finally shortlisted after rigorous screening [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ]. Since a total of 31 patients were described in the nine case series, individual data of 56 patients is described in our systematic review in the form of two tables [ Table 1 and Table 2 ].…”