Posterior reversible encephalopathy syndrome in a postpartum hemorrhagic woman without hypertension

Abstract

Rationale:Posterior reversible encephalopathy syndrome (PRES), which diagnosis is based on clinical symptoms and radiological features, is a neurotoxic disease characterized by a set of clinical manifestations, such as seizure, headache, visual, and/or consciousness disturbance. It is the first case of PRES followed by postpartum hemorrhage (PPH) without underlying disease.Patient concerns:A 37-year-old healthy woman had PPH after caesarean section. Six days after delivery, headache occurred suddenly, followed by episodes of clonus seizure.Diagnoses:Brain computed tomography showed ischemic stroke. However, magnetic resonance imaging revealed characteristics consistent with PRES.Interventions:The patient received phenytoin for seizure control.Outcomes:Seizure was under good control over the following days. Three months later, repeated magnetic resonance imaging showed complete remission.Lessons:PRES may be triggered by PPH and is not necessarily secondary to typical predisposing factors such as hypertension or pre/eclampsia. Hormone fluctuation, increased blood pressure variation, and massive blood transfusion may be contributed to the development of PRES in our case. Also, it is necessary to rule out those life-threatening diseases, such as cavernoma hemorrhage, cerebral venous thrombosis, and ischemic stroke before the diagnosis of PRES.

Predicting peripartum blood transfusion: focusing on pre-pregnancy characteristics

“…Previous observational studies showed that blood transfusion in the critically ill may have a deleterious effect on clinical outcomes, independent of illness severity or hemoglobin level [56,57]. Blood transfusion may induce not only circulatory overload, acute lung injury, and allergic reaction but also thromboembolism and stroke [5]. Peripartum transfusion increased the incidence of stroke more than 10-fold, although women who needed transfusions may also be at high risk for other stroke factors such as preeclampsia and PPH [58].…”

Predicting peripartum blood transfusion: focusing on pre-pregnancy characteristics

“…Previous observational studies showed that blood transfusion in the critically ill may have a deleterious effect on clinical outcomes, independent of illness severity or hemoglobin level [56,57]. Blood transfusion may induce not only circulatory overload, acute lung injury, and allergic reaction but also thromboembolism and stroke [5]. Peripartum transfusion increased the incidence of stroke more than 10-fold, although women who needed transfusions may also be at high risk for other stroke factors such as preeclampsia and PPH Readers should be aware of the limitations in the present study.…”

Posterior Reversible Leukoencephalopathy Syndrome Associated with Eclampsia in a Pregnant Adolescent Without Hypertension at Admission

“…Dysfunction of vascular endothelium triggers capillary leakage and disruption of the blood brain barrier ending with vasogenic edema. 7 Due to blood pressure fluctuation, arteriolar constriction and dilatation alter cerebral autoregulation. 7 This situation may cause breakdown of the blood brain barrier allowing extravasation of fluid into the brain parenchyma.…”

“…7 Due to blood pressure fluctuation, arteriolar constriction and dilatation alter cerebral autoregulation. 7 This situation may cause breakdown of the blood brain barrier allowing extravasation of fluid into the brain parenchyma. On the other hand, focal vasoconstriction leads to local hypoperfusion, cyctotoxic edema and cerebral infarction resulting in vasogenic edema.…”