• Users Online: 420
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 57  |  Issue : 4  |  Page : 326-327

Posterior reversible encephalopathy syndrome at term pregnancy with eclampsia


1 Department of Ophthalmology, Sathyan Eye Care Hospital, Coimbatore, Tamil Nadu, India
2 Department of Ophthalmology, Mahatma Gandhi Medical College, Puducherry, India

Date of Submission28-Aug-2019
Date of Decision31-Oct-2019
Date of Acceptance19-Nov-2019
Date of Web Publication26-Dec-2019

Correspondence Address:
Dr. Abhinay Ashok
Sathyan Eye Care Hospital, Sowripalyam Piruv, Coimbatore - 641 045, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_79_19

Get Permissions

  Abstract 


The incidence of eclampsia in developed countries is 1 in 3000 and the incidence of posterior reversible encephalopathy syndrome (PRES) is 1 in 400 eclampsia patients. Not many cases of PRES have been reported from Tamil Nadu. This can be an eye opener for ophthalmologists if a patient comes with a sudden loss of vision. PRES is also known as reversible posterior leukoencephalopathy syndrome. It is a cliniconeuroradiological syndrome associated with various clinical conditions presenting with headache, seizures, and cortical visual disturbance. Imaging predominantly shows parieto-occipital white matter changes with vasogenic edema being the most accepted pathophysiology. We report a 25-year-old primigravida who presented in term pregnancy with pregnancy-induced hypertension, seizures, and blindness. Magnetic resonance imaging showed subcortical signal abnormalities in the occipital lobes, which is a sign of PRES. She was managed by controlling her blood pressure levels, and emergency cesarean section was done. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment.

Keywords: Eclampsia, posterior reversible encephalopathy syndrome, pregnancy


How to cite this article:
Ashok A, Jha KN. Posterior reversible encephalopathy syndrome at term pregnancy with eclampsia. TNOA J Ophthalmic Sci Res 2019;57:326-7

How to cite this URL:
Ashok A, Jha KN. Posterior reversible encephalopathy syndrome at term pregnancy with eclampsia. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Jul 14];57:326-7. Available from: http://www.tnoajosr.com/text.asp?2019/57/4/326/273982




  Introduction Top


Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome is a rare cliniconeuroradiological condition introduced by Hinchey et al.[1] It is also known as reversible posterior cerebral edema syndrome or posterior leukoencephalopathy syndrome. Common clinical conditions associated with PRES are renal failure, hypertensive encephalopathy, autoimmune disorders, and treatment with immunosuppressant or cytotoxic medications.[2] Clinical features include headache, encephalopathy, seizures, cortical visual disturbances or blindness, and parieto-occipital white matter changes on neuroimaging.[3]


  Case Report Top


A 25-year-old primigravida at term pregnancy weighing 70 kg with gestational hypertension presented with an episode of seizures and sudden bilateral visual impairment. On general examination, she was conscious, cooperative, and oriented with blood pressure of 160/90 mmHg and afebrile. On ocular examination, visual acuity of both the eyes was 1/60 with 3 mm circular pupils well reacting to light. Magnetic resonance imaging revealed subcortical T2 hyperintensities in bilateral occipital lobes [Figure 1]. Fundus evaluation showed normal fundus [Figure 2] and [Figure 3]. The patient was managed by controlling her blood pressure after which she had an episode of seizures and emergency cesarean section was done. Both the patient and the baby were kept under observation. After 4 days of delivery, visual acuity of both the eyes was 6/60 with normal fundus. Visual acuity in 10-day follow-up was 6/6 with well-reacting pupil. Visual field was also normal. The cause for the visual disturbance here is due to vasogenic edema involving posterior cerebral circulation.[4] After 10 days when the patient was evaluated, the visual acuity in both the eyes was 6/6 with normal color vision and fundus.
Figure 1: Magnetic resonance imaging brain revealed subcortical T2 hyperintensities in bilateral occipital lobes

Click here to view
Figure 2: Normal fundus photograph of RE

Click here to view
Figure 3: Normal fundus photograph of LE

Click here to view



  Discussion Top


The incidence of eclampsia in developed countries is 1 in 2000 pregnancies and of PRES is 1 in 400 cases of eclampsia.[5] Causes for sudden loss of vision during pregnancy are preeclampsia leading to vascular abnormality, edema and ischemic optic neuropathy, papilledema, optic neuritis, cortical blindness, and serous retinal detachment.[6] PRES is reported in the settings of eclampsia/transplantation, in infection/shock, autoimmune diseases, and after cancer chemotherapy.[7] Imaging predominantly shows parieto-occipital white matter changes. PRES should be considered in pregnant women presenting with headache, seizures, and sudden loss of vision. Neuroimaging clinches the diagnosis. Reassurance should be the part of therapy in view of the reversible nature of the disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500.  Back to cited text no. 1
    
2.
Long TR, Hein BD, Brown MJ, Rydberg CH, Wass CT. Posterior reversible encephalopathy syndrome during pregnancy: Seizures in a previously healthy parturient. J Clin Anesth 2007;19:145-8.  Back to cited text no. 2
    
3.
Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 2007;28:1320-7.  Back to cited text no. 3
    
4.
Karuppannasamy D, Vikrant K, Raghuram A, Kumaar TM. Cortical visual loss in posterior reversible encephalopathy syndrome in late postpartum eclampsia: Case series. Indian J Ophthalmol 2014;62:635-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Sudulagunta SR, Sodalagunta MB, Kumbhat M, Settikere Nataraju A. Posterior reversible encephalopathy syndrome (PRES). Oxf Med Case Reports 2017;2017:245-19.  Back to cited text no. 5
    
6.
Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy syndrome: A truly treatable neurologic illness. Perit Dial Int 2012;32:590-4.  Back to cited text no. 6
    
7.
Marcoccia E, Piccioni MG, Schiavi MC, Colagiovanni V, Zannini I, Musella A, et al. Postpartum posterior reversible encephalopathy syndrome (PRES): Three case reports and literature review. Case Rep Obstet Gynecol 2019;2019:471-5.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed364    
    Printed20    
    Emailed0    
    PDF Downloaded43    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]