Atypical presentation of posterior reversible encephalopathy syndrome: a case report

Authors

  • Sri Sushma Nagasuri Department of Obstetrics and Gynaecology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India
  • Savita Konin Department of Obstetrics and Gynaecology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India
  • Meenakshi Devarmani Department of Obstetrics and Gynaecology, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20221688

Keywords:

Atypical PRES, Eclampsia, PRES

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a reversible syndrome characterized by seizures, headache, altered mentation, and loss of vision associated with white matter changes on imaging. A 25-year-old primigravida presented at 31 weeks gestation with atypical PRES characterized by generalized seizures and altered mental status. Magnetic resonance brain imaging showed high-intensity lesions in bilateral corona radiata, capsulo-ganglionic region, genu and splenium of corpus callosum, cortical and subcortical white matter of bilateral high fronto-parietal, bilateral cerebral peduncle, pons and medulla. Cases of antepartum atypical PRES are rare. Patients with atypical PRES do not always show typical manifestations. Our case reports highlight the crucial role of a prompt diagnosis, the importance of rapid blood pressure reduction, with a multidisciplinary approach.

References

Mishra SK, Bhat RR, Sudeep K, Nagappa M, Swain A, Badhe AS. PRES (Posterior Reversible Encephalopathy Syndrome) and Eclampsia: Review. Internet J Anesthesiol. 2008.;22(1).

Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A Reversible Posterior Leukoencephalopathy Syndrome. N Engl J Med. 1996;334(8):494-500.

Raman R, Devaramane R, Jagadish GM, Chowdaiah S. Various Imaging Manifestations of Posterior Reversible Encephalopathy Syndrome (PRES) on Magnetic Resonance Imaging (MRI). Pol J Radiol. 2017;82:64-70.

Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, et al. Preeclampsia-Eclampsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy. Radiology. 2000;217(2):371-6.

Liman TG, Bohner G, Heuschmann PU, Scheel M, Endres M, Siebert E. Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia-eclampsia and other predisposing diseases. Eur J Neurol. 2012;19(7):935-43.

Aracki-Trenkić A, Stojanov D, Trenkić M, Radovanović Z, Ignjatović J, Ristić S, et al. Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients. Bosn J Basic Med Sci. 2016;16(3):180-6.

Oyinloye OI, Adesiyun OM, Atobatele MO, Fawole AA. Posterior reversible encephalopathy syndrome in a adult female. Ann Afr Med. 2014;13(3):138.

Takagi H, Matsunami K, Ichigo S, Katano T, Imai A. A Typical Case of Posterior Reversible Encephalopathy Syndrome Associated with Postpartum Eclampsia-HELLP Syndrome. Open J Obstet Gynecol. 2016;6(6):355-9.

O’Kane M, Elhalwagy H, Kumar S, Badawi C. Unusual presentation of PRES in the postnatal period. BMJ Case Rep. 2014;2014:bcr2013203406.

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Published

2022-06-27

Issue

Section

Case Reports