Severe preterm preeclampsia - associated posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome which causes non-specific neurological symptoms such as visual impairment (cortical blindness, diplopia, hemianopia), acute headaches, seizures (focal or general tonic-clonic), vomiting, altered mental status, focal neurologic deficit as a complication of preeclampsia. Preeclampsia is a serious complication specific for pregnancy, characterized by hypertension (systolic > 140 mm Hg and/or diastolic > 90 mm Hg) and proteinuria (> 300 mg u 24-h urine sample , > 1 +) at or after 20th week of gestation. It is one of the leading causes of perinatal morbidity and mortality. We present a 38-year-old pregnant woman, gravida 1 para 0 with PRES which was manifested on the second day after delivery by Cesarean section at 32 weeks of gestation with aphasia and blindness caused by severe preeclampsia. We confirmed the diagnosis by MRI which revealed white matter edema in the posterior cerebral area in a symmetric fashion, hyper intense cortical foci in the right occipital lobe and punctiform lesions in the bilateral occipital lobe. We treated her promptly in the intensive care unit (ICU) with antihypertensive and anticonvulsant therapy after which she fully recovered. PRES should always be kept in mind when a patient in the postpartum period develops one of the above symptoms. If timely recognized and promptly treated, full recover usually follows