Posterior reversible encephalopathy syndrome as a complication of pre-eclampsia in the early postpartum period

Unveiling the Hidden Culprit of Posterior Reversible Encephalopathy Syndrome Superimposing Postpartum Eclampsia: A Rare Case

The rare yet potentially fatal neurological complication known as posterior reversible encephalopathy syndrome (PRES) can manifest during pregnancy. Alongside symptoms such as headaches, nausea, visual disturbances, and altered mental status, patients often experience seizures or loss of consciousness. Imaging typically reveals vascular edema affecting the parietal and occipital lobes within the subcortical region. We present the case of a 24-year-old patient who developed postpartum eclampsia followed by PRES. MRI findings demonstrated hyperintensities in the posterior parietal, frontal, and occipital lobes bilaterally, confirming the diagnosis. Prompt administration of levetiracetam and labetalol led to the resolution of the patient's symptoms. Subsequently, we thoroughly searched online databases for peer-reviewed articles examining the etiology, clinical presentation, and treatment options for PRES. Our evaluation of the case findings alongside existing literature underscored the rarity of PRES occurring concurrently with postpartum eclampsia, highlighting the importance of timely identification and intervention in managing this condition. Further research is warranted to enhance our understanding of PRES in the context of pregnancy-related complications.

Postpartum Eclampsia Complicated With Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome is an uncommon yet devastating neurological maternal complication in pregnancy. Patients typically present with headache, visual disturbances, nausea, or altered mental status, and may develop seizures or loss of consciousness. Imaging usually reveals sub-cortical vasogenic edema at the parietal and occipital lobes. We discuss a case of a 29-year-old patient who developed posterior reversible encephalopathy syndrome secondary to postpartum eclampsia. The diagnosis was made after magnetic resonance imaging revealed hyperintensities in the bilateral posterior parietal, occipital and frontal lobes. The patient’s symptoms resolved after prompt treatment with levetiracetam and labetalol. Peer-reviewed publications were then sourced from online databases to explore the etiology, clinical presentation, and management of posterior reversible encephalopathy syndrome. Our results were compared with the existing data. However, the rarity of posterior reversible encephalopathy syndrome following postpartum eclampsia in the obstetric population meant limited literature existed. Therefore, the case report is novel. Combined with findings from the literature, our results from the case report supported our findings that prompt diagnosis and management are the keys to reverse posterior reversible encephalopathy syndrome.

Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

The posterior reversible encephalopathy syndrome was characterized by Hinchey and colleagues in the 1990s. The condition frequently afflicts patients suffering from hematologic and solid organ malignancy and individuals undergoing transplantation. Cases are more frequently described in the adult population compared with children. In the pediatric population, malignancy, transplantation, renal disease, and hypertension represent the most common etiologies. Theories on pathogenesis have centered upon cerebrovascular dysautoregulation with increases in blood–brain barrier permeability. This generates vasogenic edema of the cerebral parenchyma and consequent neurologic deficits. The parietal and occipital lobes are affected with greatest prevalence, though frontal and temporal lobe involvement is frequent, and that of the contents of the infratentorial posterior cranial fossa are occasionally described. The clinical presentation involves a characteristic constellation of neurologic signs and symptoms, most typically inclusive of headache, visual-field disturbances, abnormalities of visual acuity, and seizures. Supportive care, withdrawal of the offending agent, antihypertensive therapy, and prophylactic anticonvulsants affect convalescence in majority of cases. The principal challenge lies in identifying the responsible agent precipitating the condition in patients with malignancy and those having undergone transplantation and thus deciding which medication among a multidrug treatment regimen to withhold, the duration of drug cessation required to effect clinical resolution, and the safety of resuming treatment with the compound. We accordingly reviewed and evaluated the literature discussing the posterior reversible encephalopathy syndrome in children.