Anesthesia and Intensive Care Management in a Pregnant Woman with PRES: A Case Report

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a temporary condition that is diagnosed clinically, neurologically, and radiologically. Its symptoms vary, and nonspecific headaches, confusion, impairment of consciousness, nausea, vomiting, and visual impairment may occur. Acute hypertension often accompanies these symptoms. Patients can also suffer from convulsions, cortical visual impairment, and coma. Diagnosis can be difficult due to focal neurologic signs. Nevertheless, knowing the clinical risk factors can lead to the right diagnosis. It has been reported that this condition may also occur during organ transplantation, immunosuppressive treatment, and autoimmune diseases and chemotherapy, and also patients with eclampsia. In this paper, a 21-year-old, 31-week pregnant woman, who had been diagnosed with PRES and thanks to early diagnosis and treatment had fully recovered and discharged from the intensive care unit, is presented, and the relevant literature is discussed.

Posterior reversible encephalopathy syndrome (PRES): presentation, diagnosis and treatment

“…33 The use of thiopental, valproate or phenytoin has been reported only for status epilepticus in these patients. 34 Specific cerebral antioedema therapy with steroids or mannitol has not been found to be superior to magnesium sulfate in achieving neurological recovery. 35…”

A case of recurrent posterior reversible encephalopathy syndrome

“…Presently, MRI scans represent the most important diagnostic tools for this syndrome, and due to this neuroimaging technology, we may see an increase in the diagnosis of PRES in the future. In diffusion MRI images, evidence of PRES will be consistent with vasogenic edema and will show in a typical MRI as symmetric increase signals in the bilateral parietooccipital regions, subcortical white matter of the temporal and bilateral and in the posterior areas in T2A and FLAIR sequences [12].…”

Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia

“…The pathogenesis of PRES is not fully understood and is still a matter of debate. [ 11 12 ] On the basis of the results of neuroimaging studies in eclampsia, three theories have been advanced to explain the pathogenesis of hypertensive encephalopathy in PRES. First, the potential pathophysiologic mechanism underlying the development of cerebral lesions and seizures was attributed to vasogenic edema, which occurs as a result of hyperperfusion and/or toxins that cause endothelial injury and disrupt the blood–brain barrier.…”