SummaryWe report a case of a young woman presenting with profound depression of consciousness and intra-uterine death in the late stages of an unbooked pregnancy. She proceeded to develop features of cardiovascular, renal, hepatic and haematological failures. The patient was challenging to manage in view of uncertainty regarding the underlying cause, and required multidisciplinary consultation. A diagnosis was subsequently made of posterior reversible encephalopathy syndrome in the context of pre-eclampsia. We review the typical presentation and wide-ranging associations of this recently described clinico-neuroradiological syndrome, and look at how appropriate management may lead to rapid resolution of its often life-threatening features. We highlight the importance to anaesthetists and critical care physicians of recognising even atypical cases such as this one in view of key differences in management from similarly presenting conditions. Posterior reversible encephalopathy syndrome (PRES) presents with a variety of neurological features which, although devastating, are potentially reversible on prompt recognition and institution of appropriate treatment [1], but clinicians often fail to suspect it [2]. Delayed diagnosis is frequent and can lead to long-term neurological disability. We describe a case presenting as coma and intra-uterine death in the late stages of an unbooked pregnancy. This patient was challenging to manage in view of uncertainty regarding the diagnosis and particularly serious features, and required consultation and co-ordination between obstetricians, anaesthetists, intensive care physicians, radiologists, neurosurgeons and neurologists. Case reportA 20-year-old woman was brought to a maternity hospital by ambulance having been found unconscious by her flatmates. On arrival, she was unable to maintain her own airway. An oral airway was inserted. Her respiration was laboured with a rate of 10 breaths.min . The blood pressure was 220 ⁄ 120 mmHg. Capillary refill time measured over the sternum was prolonged at 5 s. There was marked generalised oedema. The Glasgow Coma Score was 4 out of 15 (Motor 1, Eyes 1, Verbal 2). Her pupils were 5 mm in diameter, equal, and reactive. Normal tone and tendon jerk reflexes were present in both upper and lower limbs. Inspection of the abdomen revealed a third trimester pregnancy (of which her friends were unaware), and contractions of early labour. Marks on her thigh were consistent with several hours lying on the floor. Vaginal examination showed that the cervix was dilated to 2 cm with fresh meconium draining. Core temperature was elevated at 38.5°C.Initial arterial blood gas analysis showed pH 7.21, P a CO 2 6.9 kPa, P a O 2 37.0 kPa and standard base excess )6.5 mmol.l . Ultrasonography revealed a fetus with no heartbeat. Urinalysis showed ‡ 20 g.dl )1 proteinuria. A working diagnosis was made of severe preeclampsia or eclampsia with an unwitnessed seizure. Possible aetiologies of the ongoing coma were considered

The objectives of this study were: to determine the prevalence of overweight and obesity in a day‐case surgery unit; to find out if obesity is more frequent than in the general population; and to assess glucose intolerance in obese day‐case unit attendees.The study was conducted as a retrospective audit of prospectively collected observational data at a United Kingdom urban secondary care ambulatory surgery facility.The study participants comprised 829 (99.0%) patients with complete anthropometric records out of 837 undergoing preoperative assessment between April 2004 and June 2004. The main outcome measures were: prevalence of overweight and obesity according to body mass index (BMI) stratification; and glycosylated haemoglobin A1c (HbA1c), random venous plasma glucose, and prevalence of unrecognised glucose intolerance in obese patients.The results showed that 30.2% of 560 females had a BMI of 25–30kg/m2 (overweight), 19.1% 30–40kg/m2 (class 1 and 2 obesity), and 2.5% over 40kg/m2 (class 3 obesity); 45.0%, 14.9% and 0.7% of 269 males, respectively, were in these categories. The mean HbA1c of obese patients was significantly elevated at 6.33% (95% confidence interval 6.17–6.50%, p<0.001; non‐diabetic reference range 4.0–6.0%). In all, 11.4% of 70 obese females and 20.8% of 24 obese males for whom a result was available showed an HbA1c greater than 7.0% suggesting unrecognised diabetes.The prevalence of obesity in the day‐case surgery unit is similar to that of the local population. Obese ambulatory surgery patients exhibit markedly abnormal glucose tolerance. The yield of targeted opportunistic screening for diabetes is particularly high in this group with a number needed to screen of five for men and nine for women in order to detect one case likely to need pharmacological intervention. Copyright © 2006 John Wiley & Sons.