Objective: Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological disorder in which multiple rather than single episode of seizure during pregnancy is the common presenting symptom.

Case Summary: This case illustrate a 25 year old lady who is G1P0@ 36 weeks POG presented to emergency department with sudden onset recurrent generalised tonic clonic (GTC) seizure. She was unconscious when brought to the hospital with the BP 274/190 mmHg. Despite on antihypertensive and magnesium sulphate, she still had recurrent GTC seizure. She underwent emergency LSCS after condition was stable and was transferred to ICU for intensive care. CT brain was arranged and noted right occipital hypodensity with no midline shift and basal cistern was patent. There was no neurological deficit or visual disturbance after patient extubated on day 2 post operation. She recovered well after the operation and was discharged well on day 10 post operation with double antihypertensive medications.

Conclusion: PRES syndrome is not a diagnosis, and to date, there are no consensual guidelines to validate the diagnosis. The changes that observed in the imaging with clinical and neurological manifestations may merely due to the cerebral vasogenic oedema and blood brain barrier dysfunction resulting in cerebral blood perfusion abnormalities (Feske, 2011). In fact, there has been study that suggests that 97.9% patients with eclampsia will have PRES changes (Brewer et al., 2013). What is more important is to treat the patient with magnesium sulphate early if highly suggestive of eclampsia rather than later which may lead to permanent neurological deficit.

References:

BREWER, J., OWENS, M. Y., WALLACE, K., REEVES, A. A., MORRIS, R., KHAN, M., LAMARCA, B. & MARTIN JR, J. N. 2013. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. American Journal of Obstetrics and Gynecology, 208, 468.e1-468.e6.

FESKE, S. K. 2011. Posterior Reversible Encephalopathy Syndrome: A Review. Semin Neurol, 31, 202-215.