Postpartum Hellp Syndrome Associated With Posterior Reversible Encephalopathy Syndrome.

Abstract

Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a poorly understood, life-threatening multisystemic condition related to pregnancy with a rapid onset, typically observed in patients with severe pre-eclampsia. Various mechanisms may lead to diffuse endothelial damage associated with HELLP and possible brain involvement. A comprehensive review of PubMed, Embase and Cochrane databases was conducted to examine the clinical, laboratory and radiological features associated with postpartum HELLP syndrome, particularly its potential association with posterior reversible encephalopathy syndrome (PRES). This review was prompted by a rare case we encountered. The literature review identified 10 articles documenting this association during pregnancy and 7 articles reporting it in the postpartum period. Our patient developed multiple organ dysfunction (renal, hepatic, haemolysis and thrombocytopenia) postpartum associated with an arterial hypertensive profile. The patient experienced seizures along with the maintenance of an arterial hypertensive profile resistant to pharmacological therapy. Brain magnetic resonance imaging allowed the diagnosis of PRES and pituitary adenoma/apoplexy. Follow-up led to complete recovery.

Learning points: Early identification of posterior reversible encephalopathy syndrome (PRES) is essential after diagnosis of haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.Early magnetic resonance imaging is required to identify PRES lesions and guide therapy.There needs to be an opportunity to discuss therapeutic options.