Posterior reversible encephalopathy syndrome presenting as refractory postpartum seizures in a resource-constrained setting: a diagnostic dilemma and maternal near-miss from Nigeria

Abstract

Posterior reversible encephalopathy syndrome (PRES) is an uncommon complication of pregnancy, whose rarity may lead to delayed diagnosis adverse outcomes, especially when seizures persist despite standard anti-seizure regime for eclampsia. A 25-year-old primiparous with sickle cell haemoglobinopathy was admitted about 48 hours into the puerperium with generalized tonic-clonic seizures, severe hypertension and altered mental state. She was managed for eclampsia and suspected sepsis with magnesium sulphate, antihypertensives and antibiotic therapy, with transient improvement. She however deteriorated rapidly and lapsed into unconsciousness, prompting further evaluation. After a period of delay due to financial difficulties, computerized tomography scan revealed widespread bilateral vasogenic edema that was characteristic of PRES. Following the initiation of corticosteroid therapy, the seizures ceased and she achieved full neurological recovery without any deficit. This case depicts the diagnostic dilemma of persistent pregnancy-associated seizures, especially in resource-constrained settings. Heightened suspicion, early imaging and multidisciplinary vigilance are recommended for such patients.