A rare case of early onset severe preeclampsia with PRES

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome. Patients usually present with seizures, visual disturbances, headache, and altered mental state. Most accepted pathophysiology is vasogenic edema. Imaging predominantly shows parieto-occipital white matter changes. We report a 22-year-old G2P1L1 lady who presented at 23 weeks 2 days period of gestation (POG) with high blood pressure (160 /104 mm of Hg) and headache and later on developed diminished vision too. There was no sensory motor deficit. After evaluation a plan of termination of pregnancy was made, in consultation with the patient and her husband. She was put on prophylactic dose of Inj. MgSO4 and anti-hypertensives and termination of pregnancy was done with intracervical application of PGE2 gel followed by vaginal PGE1 tablet (Misoprost) application. Her vision and headache however, didn’t improve even though she was put on Inj. MgSO4 and BP was controlled with antihypertensive. She delivered within 10 hours. In view of persistence of her symptoms, a MRI brain was done in consultation with a neurophysician, two hours after the delivery that suggested edema in occipital and temporal lobe suggestive of posterior reversible encephalopathy syndrome. Approximately 6-8 hours after delivery, gradual clinical improvement in visual acuity and headache was noted. Her vision completely recovered in 6 days. This case highlights the importance of keeping this entity in mind for the prompt diagnosis and early management, thus preventing short and long-term neurological deficits in this reversible condition popularly known as PRES.