PRES (Posterior reversibleencefalopathy syndrome) in a pre-eclamptic woman with twin pregnancy – case report
Authors:
R. Jura 1; I. Šrotová 1,2; B. Adamová 1,2; A. Šprláková-Puková 3; P. Janků 4; J. Bednařík 1,2
Authors‘ workplace:
Neurologická klinika LF MU a Fakultní nemocnice Brno
1; CEITEC Brno – Středoevropský technologický institut, Masarykova univerzita
2; Radiologická klinika LF MU a FN Brno
3; Gynekologicko-porodnická klinika LF MU a Fakultní nemocnice Brno
4
Published in:
Anest. intenziv. Med., 26, 2015, č. 3, s. 156-160
Category:
Intesive Care Medicine - Case Report
Overview
Posterior reversible encefalopathy syndrome (PRES) is a serious neurological condition with varied clinical manifestation. It is rare during pregnancy. We present a case of PRES in a 35-year-old female immediately after the delivery of twins by Caesarean section. The patient fully recovered. A 35-year-old primigravida with twin pregnancy underwent a Caesarean section at 35 weeks of gestation because of pregnancy-induced preeclampsia (hypertension, proteinuria, bilateral pedal oedema). Approximately 20 hours after the Caesarean section there was a rapid decline of visual acuity. We clinically diagnosed cortical blindness. A computed tomography (CT) scan of the brain showed bilateral occipital hypodensity, CT angiogram showed no pathological findings. The patient was immediately transferred to the neurological Intensive Care Unit (ICU). Magnetic resonance showed hyperintensity (T2W2) in the occipital lobes and the cerebral trunk. After the delivery patient had been normotensive. Subsequently after the development of the neurological symptoms, the patient’s blood pressure increased to 200/110 mm Hg. PRES was diagnosed on the basis of the clinical presentation and the radiological reports and the patient was promptly treated with intravenous antihypertensives and magnesium sulphate. The visual impairment subsided within 24 hours without a relapse and the clinical neurological examination was normal. The patient was discharged in one week with normal blood pressure on oral antihypertensive medication. Pre-eclampsia is a predisposing factor for PRES in pregnancy. We report a case of uncommon post-partum PRES presentation and focus on the importance of early diagnosis and optimal critical care management.
Keywords:
Posterior reversible encefalopathy syndrom (PRES) – pregnancy – pre-eclampsia – cortical blindness
Sources
1. Bartynski, W. S. Posterior reversible encephalopathy syndrome, fundamental imaging and clinical features. AJNR Am. J. Neuroradiol., 2009, 29, p. 1036–1049.
2. Duros, A. Reversible cerebral vasoconstriction syndrome. The Lancet Neurol., 2012, 10, p. 906–917.
3. Hinchey, J., Chaves, C., Appignani, B. A reversible poste-rior leukoencephalopathy syndrome. N. Engl. J. Med., 1996, 334, p. 494–500.
4. Legriel, S. et al. Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS). Determinants of recovery from severe posterior reversible encephalopathy syndrome. PLoS One, 2012, 7, 9, p. e44534. Erratum in: PLoS One, 2013, 8, 11.
5. Servillo, G., Striano, P., Striano, S., Tortora, F., Boccella, P., De Robertis, E. et al. Posterior reversible encephalopathy syndrome (PRES) in critically ill obstetric patients. Intensive Care Med., 2003, 29, p. 2323–2326.
6. Lee, V. H., Wijdicks, E. F., Manno, E. M., Rabinstein, A. A. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch. Neurol., 2008, 65, p. 205–210.
7. Burnett, M. M., Hess, C. P., Roberts, J. P., Bass, N. M., Douglas, V. C., Josephson, S.A. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin. Neurol. Neurosurg., 2010, 112, p. 886–891.
8. Bartynski, W. S. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am. J. Neuroradiol., 2008, 29, p. 1036–1042.
9. Roth, C., Ferbert, A. Posterior reversible encephalopathy syndrome: long-term follow-up. J. Neurol. Neurosurg. Psychiatry, 2010, 81, p. 773–777.
10. Poma, S. et al. Management of posterior reversible syndrome in preeclamptic women. Case Rep. Obstet. Gynecol., 2014, 928079.
11. Haluzová, A., Jura, R., Bednařík, J., Skutilová, S., Andrašinová, T., Keřkovský, M., Křivanová, A. Subakutně probíhající reverzibilní hypertenzní leukoencefalopatie - kazuistika. Cesk. Slov. Neurol. N., 2008, 6, p. 726–731.
12. Striano, P., Striano, S., Tortora, F., De Robertis, E., Palumbo, D., Elefante, A. et al. Clinical spectrum and critical care management of Posterior Reversible Encephalopathy Syndrome (PRES). Med. Sci. Monit., 2005, 11, p. 549–553.
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2015 Issue 3
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