Posterior Reversible Encephalopathy Syndrome in Pregnancy - Relevance in Diagnosis and Management

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome, which may present with headache, encephalopathy, seizures, visual disturbances, and blindness. The lesions in PRES are due to vasogenic oedema in posterior cerebral hemispheres and can be reversible if managed accurately. MRI shows diffuse abnormal signal intensities involving deep white matter of occipital lobes. Reporting 4 cases of PRES diagnosed in our Lady Goschen Hospital, attached to KMC Mangalore in a duration of two years. In all four cases, PRES was suspected when patients presented with eclampsia persistent in spite of administration of Pritchard’s regimen. MRI confirmed diagnosis. Three of them recovered while one of the women succumbed due to status eclampticus, respiratory failure and shock. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment in the other 3 patients. In order to prevent irreversible brain damage, correct clinical suspicion and timely diagnosis with apt management is essential. If adequate blood pressure-titrated treatment is followed, there may be speedy recovery from eclampsia and hence improvement in maternal condition.