Posterior Reversible Encephalopathy Syndrome as a Postpartum Complication
DOI:
https://doi.org/10.3889/oamjms.2018.193Keywords:
Posterior reversible encephalopathy syndrome (PRES), MRI, Postpartum cesarean, Epileptic seizures, Cortical blindnessAbstract
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome with seizures, altered consciousness, visual disturbances and headache among other symptoms. Hinchey et al. first described Pres in 1996, with two other case series published shortly after.
CASE REPORT: A 23-year-old women patient was emergency sent from General Hospital Tešanj due to a crisis of consciousness and repeated epileptic seizures. The patient had a second birth before 10 days (postpartum cesarean) in general endotracheal anaesthesia (two cesarean-born babies). On magnetic resonance imaging (MRI) of cranium described both sides of the symmetrically frontal, parietal (and pre-ventricular gyri) and occipitally visible T2W/FLAIR hyperintensity focuses on the cortex and the thin layer of white mass subcortically. In the projection of the lesions parts, discrete DWI hyperintensity is seen without a reliable ADC correlate. The patient improved after management with intravenous fluids, antibiotics, antiepileptics and monitoring of blood pressure. According to latest experiences delayed diagnosis and treatment may lead to mortality or irreversible neurological deficit. Aggravating circumstances are differential diagnoses that include cerebral infarction (ischemic, haemorrhage), venous thrombosis, vasculitis, pontine or extrapontine myelinolysis.
CONCLUSION: MRI of the brain is key to make this distinction with crucial recognition and an open mind from radiology and neurology specialist.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007; 189(4):904-912. https://doi.org/10.2214/AJR.07.2024 PMid:17885064
Roth C, Ferbert A. The posterior reversible encephalopathy syndrome: what's certain, what's new? Pract Neurol. 2011; 11(3):136-144. https://doi.org/10.1136/practneurol-2011-000010 PMid:21551107
Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996; 334(8):494-500. https://doi.org/10.1056/NEJM199602223340803 PMid:8559202
Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, Holman BL. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992; 159(2):379-383. https://doi.org/10.2214/ajr.159.2.1632361 PMid:1632361
Schwartz RB, Bravo SM, Klufas RA, Hsu L, Barnes PD, Robson CD, Antin JH. Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol. 1995; 165(3):627-631. https://doi.org/10.2214/ajr.165.3.7645483 PMid:7645483
Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy syndrome: a truly treatable neurologic illness. Perit Dial Int. 2012; 32(6):590-594. https://doi.org/10.3747/pdi.2012.00152 PMid:23212858 PMCid:PMC3524908
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000; 356(9227):411-417. https://doi.org/10.1016/S0140-6736(00)02539-3
Shin KC, Choi HJ, Bae YD, Lee JC, Lee EB, Song YW. Reversible posterior leukoencephalopathy syndrome in systemic lupus erythematosus with thrombocytopenia treated with cyclosporine. J Clin Rheumatol. 2005; 11(3):164-166. https://doi.org/10.1097/01.rhu.0000164825.63063.43 PMid:16357738
Min L, Zwerling J, Ocava LC, Chen IH, Putterman C. Reversible posterior leukoencephalopathy in connective tissue diseases. Semin Arthritis Rheum. 2006; 35(6):388-395. https://doi.org/10.1016/j.semarthrit.2006.01.003 PMid:16765716
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0