Anest. intenziv. Med. 2015;26(3):156-160

PRES (Posterior reversibleencefalopathy syndrome) in a pre-eclamptic woman with twin pregnancy - case reportIntesive Care Medicine - Case Report

R. Jura^1,*, I. Šrotová^1,2, B. Adamová^1,2, A. Šprláková-Puková³, P. Janků⁴, J. Bednařík^1,2

¹ Neurologická klinika LF MU a Fakultní nemocnice Brno

² CEITEC Brno - Středoevropský technologický institut, Masarykova univerzita

³ Radiologická klinika LF MU a FN Brno

⁴ Gynekologicko-porodnická klinika LF MU a Fakultní nemocnice Brno

Posterior reversible encefalopathy syndrome (PRES) is a serious neurological condition with varied clinical manifestation. It is rare during pregnancy. We present a case of PRES in a 35-year-old female immediately after the delivery of twins by Caesarean section. The patient fully recovered. A 35-year-old primigravida with twin pregnancy underwent a Caesarean section at 35 weeks of gestation because of pregnancy-induced preeclampsia (hypertension, proteinuria, bilateral pedal oedema). Approximately 20 hours after the Caesarean section there was a rapid decline of visual acuity. We clinically diagnosed cortical blindness. A computed tomography (CT) scan of the brain showed bilateral occipital hypodensity, CT angiogram showed no pathological findings. The patient was immediately transferred to the neurological Intensive Care Unit (ICU). Magnetic resonance showed hyperintensity (T2W2) in the occipital lobes and the cerebral trunk. After the delivery patient had been normotensive. Subsequently after the development of the neurological symptoms, the patient's blood pressure increased to 200/110 mm Hg. PRES was diagnosed on the basis of the clinical presentation and the radiological reports and the patient was promptly treated with intravenous antihypertensives and magnesium sulphate. The visual impairment subsided within 24 hours without a relapse and the clinical neurological examination was normal. The patient was discharged in one week with normal blood pressure on oral antihypertensive medication. Pre-eclampsia is a predisposing factor for PRES in pregnancy. We report a case of uncommon post-partum PRES presentation and focus on the importance of early diagnosis and optimal critical care management.

Keywords: Posterior reversible encefalopathy syndrom (PRES); pregnancy; pre-eclampsia; cortical blindness

Received: December 20, 2014; Accepted: March 15, 2015; Published: June 1, 2015  Show citation