Extensive Posterior Reversible Encephalopathy Syndrome in Late-Onset Eclampsia: a Case Report
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MEDICINE
Extensive Posterior Reversible Encephalopathy Syndrome in Late-Onset Eclampsia: a Case Report Leonardo Sinisi 1,2
&
Fabrizio Sinisi 3 & Giuseppe Maria Ernesto La Tessa 4
Accepted: 23 September 2020 # Springer Nature Switzerland AG 2020
Abstract The posterior reversible encephalopathy syndrome (PRES) is characterized by several neurological signs and symptoms from different pathological causes. The interpretation of magnetic resonance imaging (MRI) is crucial in atypical presentations, to avoid a misdiagnosis and delays in treatment, as in the identification of complicating factors. Differentiating reversible vasogenic edema from cytotoxic edema is possible with diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) mapping. We present a case of puerperal extensive PRES related to late-onset eclampsia, in a 36-year-old first-time pregnant woman with no previous history of hypertension or other risk factors, associated with a severe clinical picture but with a full recovery in few weeks. We conclude that the prognosis of puerperal PRES should be good, if underlying etiology can be treated satisfactorily, in extensive MRI involvement too. Keywords PRES . Late-onset eclampsia . MRI . Case report
Introduction The posterior reversible encephalopathy syndrome (PRES), first described in 1996 by Hinchey et al. [1], is characterized by a variety of symptoms, including headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits usually with a potentially reversible pattern at brain magnetic resonance imaging (MRI). PRES could be caused by a vasogenic mechanism for a rapid increase in blood pressure or in some conditions by the presence of circulating toxins that could cause the formation
of edema due to the release of immunogenic and vasoactive substances [2]. PRES should always be considered in women with acute hypertension disorders associated with epileptic seizures or other neurological symptoms during pregnancy and in the postpartum. The characteristic of the imaging pattern is characterized by the presence of edema involving the white matter of the posterior portions of both cerebral hemispheres, especially the parieto-occipital regions [3]. Here we present a case of late-onset eclampsia and concurrent extensive PRES (ePRES), associated with a severe clinical picture, characterized however by complete recovery after a few weeks.
This article is part of the Topical Collection on Medicine * Leonardo Sinisi [email protected] 1
Neurology Unit, S. Paolo Hospital, ASL Napoli 1 Centro, Via Terracina 219, 80125 Naples, NA, Italy
2
Naples, Italy
3
Ophthalmology, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
4
Neuroradiology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Naples, NA, Italy
Case Report A 36-year-old first-time pregnant woman with no history of hypertension or other risk factors for PRES underwent cesarean section (CS) with spinal anesthesia at 39 wee
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