|Year : 2019 | Volume
| Issue : 4 | Page : 326-327
Posterior reversible encephalopathy syndrome at term pregnancy with eclampsia
Abhinay Ashok1, Kirti Nath Jha2
1 Department of Ophthalmology, Sathyan Eye Care Hospital, Coimbatore, Tamil Nadu, India
2 Department of Ophthalmology, Mahatma Gandhi Medical College, Puducherry, India
|Date of Submission||28-Aug-2019|
|Date of Decision||31-Oct-2019|
|Date of Acceptance||19-Nov-2019|
|Date of Web Publication||26-Dec-2019|
Dr. Abhinay Ashok
Sathyan Eye Care Hospital, Sowripalyam Piruv, Coimbatore - 641 045, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
Posterior reversible encephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome is a rare cliniconeuroradiological condition introduced by Hinchey et al. 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. Clinical features include headache, encephalopathy, seizures, cortical visual disturbances or blindness, and parieto-occipital white matter changes on neuroimaging.
| Case Report|| |
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. 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|
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| Discussion|| |
The incidence of eclampsia in developed countries is 1 in 2000 pregnancies and of PRES is 1 in 400 cases of eclampsia. 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. PRES is reported in the settings of eclampsia/transplantation, in infection/shock, autoimmune diseases, and after cancer chemotherapy. 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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]