A case of the first presentation of pre-eclampsia and eclampsia as posterior reversible leukoencephalopathy syndrome: A case report

Posterior reversible leukoencephalopathy syndrome [PRES] is a rare disorder which is usually associated with a wide variety of diseases including renal diseases, autoimmune diseases, hypertension, pre-eclampsia and immunosuppressive therapy. The exact aetiology remains unknown.  Even though there are cases of PRES occurring in patients with pre-eclampsia, cases of the first presentation of pre-eclampsia and eclampsia as PRES are rare. Here we report a case of a previously healthy primigravida presenting with generalized tonic-clonic convulsions. Her blood pressure had been normal throughout pregnancy as well as on admission. Following admission there were two high blood pressure recordings. Pre-eclamptic toxaemia [PET] screening reported as positive, indicating pre-eclampsia. Magnetic resonance imaging [MRI] brain was suggestive of PRES. She was treated with magnesium sulphate, anticonvulsants and antihypertensives after which seizures were controlled and blood pressure was normalized. Emergency lower segment caesarean section was performed and the baby was delivered without any complications. Therefore, it is important to consider PRES as a differential diagnosis in a pregnant patient presenting with convulsions even in the absence of a background history of pre-eclampsia. Early recognition and treatment of PRES will enhance prognosis.