Abstract

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN A POSTPURTAM PRE-ECLAMPSIA PATIENT (PRES): A CASE REPORT

*Chiranjit Das, Batthula Shiva Rani

Abstract

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a rare but potentially fatal neurological condition characterized by seizures, headache, altered sensorium, and visual disturbances. It is commonly associated with hypertensive disorders of pregnancy and may occur during the postpartum period due to endothelial dysfunction and impaired cerebral auto regulation. Case Presentation: A 26-year-old primiparous woman presented nine days after lower-segment caesarean section performed for fetal distress with two episodes of seizures associated with uncontrolled limb movements, frothing from the mouth, and up rolling of eyes. At admission, she was normotensive; however, she subsequently developed neurological symptoms along with fluctuating blood pressure exceeding 150/100 mmHg. Investigations: Magnetic resonance imaging and venography of the brain revealed diffusion restriction in the right posterior parietal lobe and multifocal gyral signal alterations in the bilateral frontal and parietal lobes, suggestive of PRES with associated cytotoxic oedema. Laboratory investigations were within normal limits except for mild electrolyte imbalance. Management and Outcome: The patient was managed with magnesium sulphate, anticoagulants, antiepileptics, antihypertensive, and supportive therapy. Following treatment, her clinical condition stabilized without further neurological deterioration. Conclusion: This case highlights the significant role of blood pressure fluctuations and endothelial dysfunction in the development of PRES in postpartum pre-eclampsia, even in the absence of severe hypertension at presentation. Early clinical suspicion, prompt neuroimaging, and timely multidisciplinary management are essential to prevent long-term neurological sequelae and ensure favourable outcomes.

Keywords: Apparent Diffusion Coefficient, Bronchial Artery Embolization, Reversible Cerebral Vasoconstriction Syndrome, Fluid Attenuated Inversion. Posterior Reversible Encephalopathy Syndrome.