Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia

Brewer, Justin; Owens, Michelle; Wallace, Kedra; Reeves, Amanda A.; Morris, Rachael; Khan, Majid; LaMarca, Babbette; Martin, James N.

doi:10.1016/j.ajog.2013.02.015

Cited by 181 publications

(162 citation statements)

References 35 publications

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“…3%).Whereas several studies reported headache and visual disturbances/visual loss to be the common symptoms. 3,4,8,[19][20][21] We observed epigastric pain in 26.7% patients and visual disturbances were present in very few patients (3.3%). Since MRI is safe to use in pregnancy, its widespread utilization enhances the diagnosis of PRES in eclamptic women with neurological findings (Figure 2a-2d).…”

Section: Figure 1: Persistent Symptomsmentioning

confidence: 65%

“…Review of literatures and previous case reports reported that it also can occur without seizures in preeclamptic women. 8 As the name suggest, it is reversible once underlying cause is treated. The pathophysiology behind PRES is not clearly understood and two mechanisms have been put forth, failure of auto regulation and endothelial dysfunction resulting in vasogenicoedema.…”

Section: Resultsmentioning

confidence: 99%

“…31 Gradual correction of the hypertension (target systolic 140-150 and diastolic 90-105 mm Hg) is advisable to protect mother and adverse effect on uteroplacental perfusion and foetal status. 8 Roth C had reported that PRES can develop without a significant elevation in blood pressure, like eclampsia can occur at blood pressure that that are considered as normal. 18,32 Mean BP of our patients with PRES (187/110) and were treated with IV labetalol, hydralazine and Nifidepine, this results are similar to Brewer J study where as Nelli et al and Wgners J have reported that the levels of blood pressure elevation were lower (peak SBP 173 mm Hg).…”

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

“…8,33 Other antiepileptic medications alone or together with MgSO4, such as diazepam, phenytoin and valproic acid are used for seizure control in patients with recurrent seizures but their use is not approved by all authors because of their side effects. Eclampsia with recurrent seizures were controlled with MgSO4 (100%) alone in our study where as Shobhabhomalgi study reported only 67% responded to MgSO4 and others required additional anticonvulsants to control the seizures.…”

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

“…3 Junewar et al conducted a prospective observational study, to study the predictors of posterior encephalopathy syndrome, but the sample size of the study was small. 7,8 The purpose of this study was to study the maternal and foetal outcome and associated complications in patients with eclampsia with PRES. 4 …”

Section: Introductionmentioning

confidence: 99%

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Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

Karanth

Gonsalves

Sheela

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: PRES can be associated with number of medical conditions and was observed frequently in patients with preeclampsia and eclampsia. Neuroimaging is important for the diagnosis of PRES. Study was conducted to find out the maternal and perinatal outcome in patients with eclampsia complicated by posterior reversible encephalopathy syndrome (PRES).Methods: This is a retrospective study done at St. Johns Medical College Bangalore, between October 2013 and October 2016. We reviewed case records of all the patients with eclampsia who underwent neuro imaging studies and a diagnosis of PRES was made. The maternal and perinatal outcomes in these women were studiedResults: In the past three years we had 55 cases of eclampsia who underwent neuroimaging studies for persistent neurological symptoms after 24 hours of MgSO4 treatment. Of these women 30 were diagnosed to have PRES. In the present study PRES was common in multiparous women and more in patients with antepartum eclamptic women. Mean age at diagnosis of PRES was 26±5.1 years. Common presenting symptoms were headache (93.3%) and vomiting (53.3%). The mean SBP/DBP was 180/110 mmHg. All patients who had recurrent seizures were controlled with MgSO4 alone. 53.3% of our patients had eclampsia related complications and 36.7% required ICU care. There were 3 maternal deaths (10%). Perinatal mortality was 20%.Conclusions: Neuroimaging in eclamptic patients with persistent neurological symptoms could help in early diagnosis of PRES and multidisciplinary approach in management could contribute significantly in reducing the maternal mortality and morbidity.

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