Reversible Posterior Leukoencephalopathy Syndrome Accompanying Eclampsia: Correct Diagnosis Using Preoperative MRI

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by clinical symptoms such as seizures, visual disturbance, and altered mental status. It also presents abnormal findings on computed tomography (CT) and magnetic resonance imaging (MRI) indicating cerebral edema in the white matter of the occipital, temporal, and parietal lobes. Both the clinical symptoms and abnormal imaging findings can be reversed by controlling blood pressure or treating the underlying condition including infection. This report describes a patient with RPLS that occurred secondary to eclampsia. A 26-year-old female, gravida 0 para 0, developed weakness and pain in her upper and lower extremities and gait disturbance during the 34th week of pregnancy, and severe pregnancy-induced hypertension near the end of the 37th week. On the first day of the 38th week, she developed constricted visual fields and complained of visual illusions. MRI revealed a high-signal-intensity area in the right occipital lobe. Immediately after MRI, the patient had a 10-sec tonic convulsion. Diagnosed with eclampsia, she underwent emergency cesarean section. MRI on the 2nd postoperative day showed that the high-signal-intensity area was slightly improved. Her visual illusions were diminished by the 4th postoperative day, and almost all subjective symptoms disappeared by the 7th postoperative day. The patient was discharged at 12th postoperative day. We recommend MRI not only for symptomatic patients with suspected RPLS, but also for asymptomatic patients with severe pregnancy-induced hypertension. If findings such as cerebral edema are observed on MRI, immediate delivery should be considered before eclamptic seizures or exacerbation of neurological symptoms.

Cranial MR Imaging in Eclampsia and Severe Preeclampsia: A Prospective Study

“…Both these patients went on to develop seizures on post natal day 2. This finding is consistent with the findings of previous studies 20 in which investigators have shown that endothelial damage in patients with preeclampsia-eclampsia is not a result of hypertension but actually precedes substantial blood pressure increases. The endothelial dysfunction experienced by these patients is more likely related to circulating endothelial toxins or antibodies against the endothelium.…”

“…[17][18][19] However PRES has been demonstrated in women with severe preeclampsia without seizure, and it has been demonstrated to precede eclamptic convulsion. 20 In our study, out of 21 patients with positive MRI findings 3 patients were diagnosed with severe Preeclampsia. Two of these three (66.66%) patient developed seizures on postnatal day 2.…”

Posterior reversible encephalopathy syndrome (PRES) in a patient with late postpartum eclampsia

“…Clinically, PRES presents with headache, seizures, encephalopathy, visual disturbances and focal neurological symptoms 19. As the name suggests, reversibility of these symptoms is one of the hallmarks of the disease.…”

Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

“…1 Nearly half of the neurological events related to pregnancy consist of intracerebral hemorrhage, venous thrombosis, subarachnoid hemorrhage and infarction, and the remainder are pregnancy related encephalopathy. 2 Here, we describe a patient with posterior reversible encephalopathy syndrome (PRES) and intracerebral hemorrhage that had occurred secondary to HELLP syndrome.…”

“…PRES syndrome was first described by Hinchey et al in 1996 2. Symptoms of PRES in the general population comprise clinical seizures (87%), encephalopathy (92%), visual symptoms (39%), Axial CT (a)-(c) and MR (d)-(f) images on the 2nd day the hematoma in the right hemisphere, density and signal abnormalities expanded, and became more evident, contrarily subarachnoid hemorrhage disappeared.…”