Posterior reversible encephalopathy syndrome and pregnancy: a Moroccan retrospective study of a patient’s oligo series


  • Aboubakr Benjilany Department of Obstetrics and Gynecology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
  • Jaouad Kouach Department of Obstetrics and Gynecology, Military Hospital of Instruction Mohamed V, Rabat, Morocco



PRES, Pregnancy, Retrospective studies, Morocco


Posterior reversible encephalopathy syndrome (PRES) is an entity combining reversible central nervous system damages with characteristic magnetic resonance imaging (MRI) brain imaging, it can occur in peripartum regardless of any preexisting pathology. PRES in peripartum is a poorly understood phenomenon. Early diagnosis and management are essential to prevent irreversible neurological sequelae. We report 6 cases series of PRES, collected at obstetrics and gynecology department of the military hospital Mohamed V in Rabat, between 2000 and 2019, in order to describe and analyze epidemiological, clinical, paraclinical and therapeutic aspects. Average age was 27 years old. Found symptoms were: high blood pressure, seizures, headaches, visual disturbances, consciousness disorders, vivid osteotendinous reflexes, vertigo, nausea and vomiting. Associated complications were status epilepticus, eclampsia, haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and acute lung edema. Radiologically, found lesions are suggestive of PRES. After management, evolution was favorable in all patients.



Etesse B, Letouzey V, Roger C, Lefauconnier A, Ripart J. L’anesthésie péridurale n’est pas la seule cause de troubles neurologiques centraux durant le travail obstétrical. Un cas de syndrome d’encéphalopathie postérieure réversible. Anna Françaises d’Anesthésie et de Réanimation. 2011;30:57-60.

Ducros A. Réversible cérébral vasoconstriction syndrome. Lancet Neurol. 2012;11:906-17.

Cunningham FG, Twickler D. Cerebral edema complicating eclampsia. Am J Obstet Gynecol. 2000;182:94-100.

Brewer J, Martin J, Armstrong A. Eclampsia and posterior reversible encephalopathy syndrome (PRES): cause or effect or both in 47 patients? Am J Obstetr Gynecol. 2012;206:342.

Loureiro R, Leite CC, Kahhale S. Diffusion imaging may predict reversible brainlesions in eclampsia and severe preeclampsia: initial experience. Am J Obstet Gynecol. 2003;189:1350-5.

Araqi-Houssaini A, Salmi S, Moussaid I, Guennoun MA, Elyoussoufi S, Miguil M et al. Syndrome d’encéphalopathie postérieure réversible et éclampsie: étude descriptive de 13 cas au Maroc. Revue neurologique. 2011;167:812-9.

Harandou M, Madani N, Labibe S, Messouak O, Boujraf S, Benkirane S et al. Apport de l’imagerie neurologique chez les éclamptiques encore symptomatiques après 24 heures: étude descriptive à propos de 19 cas. Ann françaises d'anesthésie et de réanimation. 2006;25(6):577-83.

Zeeman G, Fleckenstein JL, Twickler DM, Cunningham FG. Cerebral infarction in eclampsia. Am J Obstetr Gynecol. 2004;190:714-20.

Marrone LC, Gadonski G, Diogo LP, Brunelli JPF, Martins WA, Laguna GDO et al. Posterior reversible encephalopathy syndrome: differences between pregnant and non-pregnant patients. Neurol Int. 2014;6(1):5376.

Sharma S, Bagga R, Modi M. Paraparesis with complete recovery in antepartum eclampsia. Int J Gynecol Obstetr. 2006;93:242-3.

Sibai BM, Spinnato JA, Watson DL, Lewis JA, Garland D, Anderson GD. Eclampsia. IV. Neurological findings and future outcome. Am J Obstet Gynecol. 1985;152:184-92.

Kozak OS, Wijdicks EF, Manno EM, Miley JT, Rabinstein AA. Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology. 2007;69:894-7.

Cruz-Flores S, De Assis Aquino Gondim F, Leira EC. Brainstem involvement in hypertensive encephalopathy: clinical and radiological findings. Neurology. 2004;62:1417-9.

Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 2006;27:2179-90.

Sengar AR, Gupta R, Dhanuka A, Roy R, Das K. MR imaging, MR angiography, and MR spectroscopy of the brain in eclampsia. AJNR Am J Neuroradiol. 1997;18:1485-90.

Mukherjee P, McKinstry RC. Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging. Radiology. 2001;219:756-65.

Papoutsis D, El-Attabi N, Sizer A. Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: case report. Clin Exp Obstet Gynecol. 2014;41(3):351-3.

Natsume J, Sofue A, Yamada A, Kato K. Electroencephalographic (EEG) findings in posterior reversible encephalopathy associated with immunosuppressants. J. Child Neurol. 2006;21(7):620-23.

Maramattom BV, Zaldivar RA, Glynn SM, Eggers SD, Wijdicks EFM. Acute intermittent porphyria presenting as a diffuse encephalopathy. Ann neurol. 2005;57(4):581-4.

Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146(1):34-44.

Lee VH, Wijdicks EF, Manno EM. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65:205-10.

Sigurta A, Terzi V, Regna-Gladin C, Fumagalli R. Posterior Reversible Encephalopathy Syndrome Complicating Traumatic Pancreatitis. Medicine. 2016;95(22):e3758.

Digre KB, Varner MW, Osborn AG. Cranial magnetic resonance imaging in severe preeclampsia vs eclampsia. Arch Neurol. 1993;50(4):399-406.

Solinas C, Briellmann RS, Harvey AS, Mitchell LA, Berkovic SF. Hypertensive encephalopathy. Antecedent to hippocampal sclerosis and temporal lobe epilepsy? Neurology. 2003;60(9):1534-6.

Salmi S, El youssoufi S, Araqi-houssaini A. La leucoencéphalopathie postérieure réversible au cours de l’éclampsie étude de série. Ann Françaises d’Anesthésie et de Réanimation. 2009;28:132-5.






Case Series