Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that can cause different ophthalmological and neurological symptoms. Preeclampsia toxemia or eclampsia is one of the leading causes of PRES. Herein, we present a study of a 35-year old woman who gave birth to healthy twins at 35 weeks of gestation by cesarean section because of threatened preterm delivery. On the 1st postoperative day, the woman developed a severe headache, arterial hypertension, tachycardia, generalized tonic–clonic seizures, and loss of consciousness that persisted for about 2 min. A provisional diagnosis of eclampsia was made, and the woman was then quickly transferred to the intensive care unit where she was treated with antihypertensive therapy, magnesium sulphate, and diazepam. Following stabilization of the general condition, the patient noticed sudden bilateral blindness. An ophthalmological examination revealed significant bilateral loss of vision at the level of insecured light perception, normal pupillary responses to a light stimulus, and normal fundus findings. On this basis, an ophthalmologist made the diagnosis to cortical blindness. Radiographic analysis showed an edematous change in the occipital and parietal brain regions, thus suggesting a diagnosis of PRES. In conclusion, cortical blindness is a clinically striking ophthalmic disorder that may occur in PRES associated with postpartum eclampsia.

Oxytocin and Vasopressin, and the GABA Developmental Shift During Labor and Birth: Friends or Foes?

“…It is important to stress that [Cl − ] i levels measures even within the same laboratory are variable. Thus, we reported values extending from strongly hyperpolarizing to equipotential with V rest and even slightly depolarizing (Tyzio et al, 2003 , 2008 ; Chiesa et al, 2018 ). This most likely reflects the importance of external conditions, animal house conditions, stress, intrinsic permeability to HCO 3 .…”

Ophthalmic Disorders in Posterior Reversible Encephalopathy Syndrome Associated with Preeclampsia

“…The diagnosis of PRES cannot be established exclusively on clinical findings [1]. Brain lesions are usually located in the white matter, although rarely, overlying cortex may also be affected [20]. The parieto-occipital regions of the brain are main foci of changes, that are usually bilateral and symmetric.…”

“…Cortical blindness is among the best-documented complications of preeclampsia/eclampsia and affects almost 15% of eclamptic women [30,31]. Cortical blindness is caused by a dysfunction in the visual pathway that conducts visual information from the lateral geniculate nucleus of the thalamus to the cerebral visual cortex [20]. Vasogenic edema is the main cause of cortical blindness.…”