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a & b MRI of patient with HELLP syndrome A 35-year-old pregnant women at 37 weeks of gestational experiencing severe pre-eclapmsia, headache and HELLP syndrome. Brain MRI revealing grossly symmetric hyperintensities over bilateral basal ganglia, thalami (white arrows) and occipital lobes (white arrowheads) on FLAIR, but minimal hyperintensities on DWI (b), consistent with typical PRES with vasogenic edema 2 (c) MRI with multiple hyperintensity changes Brain MRI of a 39-year-old pre-eclamptic pregnant women having headache at 28 weeks of gestation. Axial FLAIR disclosed symmetric hyperintensities on bilateral medial temporal lobes (white arrows) and occipital subcortical white matters (white arrowheads), suggestive of the mild form of PRES 2 (d) MRI with micro-hemorrhage A 25-year-old pregnant woman with gestational age of 26 weeks presented with headache and hypertension up to 200/100 mmHg. A profound hypointense focus on the periventricular white matter of left occipital horn was observed by SWI, indicating of a microhemorrhage (white arrow) and a precedent change of PRES onset
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Background:
A high incidence of posterior reversible encephalopathy syndrome (PRES) has been observed in women with eclampsia on imaging. However this association was documented mostly after convulsions occurred. This study aimed to detect the development of PRES using magnetic resonance imaging (MRI) in women with severe preeclampsia and headache...
Citations
... According to the study by Chao et al. in the literature, the majority of patients with eclampsia actually have PRES, but when the patient has convulsions, the diagnosis can be made less frequently than necessary because the diagnosis is made with neurological imaging and evaluations. Especially in women with severe preeclampsia and headache, if MRI is performed, it can be detected at a higher rate (8). ...
Objective: The aim of this study is to evaluate the risk factors and clinicalcourse in cases of posterior reversible encephalopathy syndrome (PRES).Material and Methods: In this study, we retrospectively reviewed the dataof pregnant or puerperal women diagnosed with PRES in the tertiarycenter emergency obstetrics outpatient clinic and intensive care unitbetween 2017 and 2022. All patients were evaluated by obstetrics,neurology, ophthalmology, radiology, and intensive care physicians, andblood tests and imaging were performed in the same center. Applicationcomplaints, laboratory values, imaging methods, comorbidities, mode ofdelivery, and postpartum period were evaluated for each patient.Results: In five years, a total of seven patients were diagnosed with PRESbased on imaging methods and clinical findings. One of these patients hadPRES twice, three years apart. Six of them presented with eclampsia. Onepatient was diagnosed with PRES postpartum in the first week, whileother patients were diagnosed at pregnancy. Four patients had blurredvision, two patients had blindness, and one patient had no visualcomplaints. Three of the patients had mood changes (one patientconfused, two patients agitated). One of the patients had diabetesmellitus (DM), which was known and treated with oral antidiabetics. Onepatient was under follow-up and treatment because of hypertension (HT)that started before pregnancy and three patients were under follow-updue to hypertension that started during pregnancy. There was no knownadditional disease in one patient. The delivery week of the patients wasbetween 28 and 34 weeks of gestation. Pathological laboratory valueswere most frequently seen in LDH, albumin, and protein values. Everypatient was discharged with outpatient follow-up. Epilepsy continues inone patient, HT in two patients, and isolated nephropathy in one patientafter PRES.Conclusion: PRES should be considered especially in pregnant womenwith neurological symptoms including visual impairment and headache.Clinical suspicion and neuroimaging are required for the diagnosis of PRES.
... Los principales signos y síntomas presentes en este tipo de pacientes son: encefalopatía, convulsiones, cefalea, trastornos visuales, déficit neurológico focal y estado epiléptico (Burnett et al., 2010;Liman et al., 2012;Li et al., 2012;Fugate & Rabinstein, 2015). El inicio de los síntomas neurológicos suele ser subagudo, sin pródromos y desaparición entre el tercer y octavo días (Chao et al., 2020;Singh et al., 2021). ...
La obra aborda aspectos importantes como: factores de riesgos, clasificación, algunas condiciones intrínsecas y extrínsecas vinculadas a esta patología, su etiopatogenia y fisiopatología, complicaciones maternas y perinatales; así como sus protocolos de atención, destacándose: el control de la hipertensión arterial, prevención de la convulsión eclámptica, vigilancia biológica y optimización de la extracción; con el propósito de estabilizar a la gestante en espera de la interrupción del embarazo como tratamiento definitivo que será dependiente de la edad gestacional y las condiciones clínicas materno fetales.
... 12 El inicio de los síntomas neurológicos suele ser subagudo, sin pródromos y desaparición entre el tercer y octavo días. 1,13 Las convulsiones generalizadas son, a menudo, la manifestación clínica más común. 14 Cuando no desaparecen pueden terminar en estatus convulsivo generalizado, requerimiento de ventilación mecánica invasiva e ingreso a cuidados intensivos. ...
... 19 Las lesiones pueden extenderse a estructuras cerebrales como: lóbulos frontales (68%), tem-porales (40%), hemisferios cerebelosos (30%), ganglios basales (14%), tronco encefálico (13%) y sustancia blanca profunda (10%). 13 En una cohorte prospectiva se encontró que los lóbulos anteriores pueden afectarse, igual a lo reportado en una paciente en quien se afectaron las regiones anteriores y posteriores cerebrales. 22 Aunque en nuestro estudio no se consiguió el seguimiento de las imágenes para la desaparición del edema, es sabido que estas lesiones desaparecen en el 70% de los casos en el transcurso de las dos primeras semanas. ...
OBJECTIVE: To describe the clinical and imaging characteristics of patients with posterior reversible encephalopathy seen in an intensive care unit.
MATERIALS AND METHODS: Retrospective, descriptive, cross-sectional case series study performed in patients with a diagnosis of reversible posterior encephalopathy secondary to hypertensive disorders attended in the intensive care unit of the Hospital Universitario de la Samaritana, Bogotá, Colombia, between January 1, 2013 and December 31, 2020.
RESULTS: We found 12 patients with reversible posterior encephalopathy; 8 of them with onset during the immediate puerperium and 4 in the mediate puerperium. Eclampsia was diagnosed in 6 patients during pregnancy and in 5 during the postpartum period The most common symptoms were headache and convulsions. Imaging findings showed edema most frequently in the posterior lobes of the brain, especially in the bilateral occipital and parietooccipital lobes. All patients were discharged from the hospital without irreversible neurological lesions.
CONCLUSIONS: Reversible posterior encephalopathy is uncommon but should be considered in patients with neurologic symptoms concomitant with hypertensive disorders of pregnancy. Although the sample is small, it can be mentioned that radiological diagnosis with brain magnetic resonance imaging, timely treatment, and multidisciplinary interventions decrease the risk of irreversible neurological lesions and fatal outcomes.
KEYWORDS: Encephalopathy; Intensive Care Unit; Colombia; Puerperium; Eclampsia; Neuroimaging; Brain magnetic resonance; Brain; Brain diseases; Fatal outcome.
Posterior reversible encephalopathy syndrome (PRES) is considered a neuroclinical syndrome of headache, confusion, visual changes, and seizures associated with neuroimaging findings of posterior cerebral white matter edema. Although the incidence of the syndrome is largely unknown, this condition is becoming increasingly recognized. The prognosis is generally good with most symptoms resolving within one week and lesions on imaging resolving in two weeks. Death and significant neurological disability have been reported but are relatively rare. In this report, we present a 10-day postpartum patient with an atypical history of headache and seizure-like activity. Neuroimaging revealed findings consistent with PRES as well as a rare complication of subarachnoid hemorrhage. This case highlights the importance of clinicians considering preeclampsia/eclampsia-induced PRES when encountering a postpartum patient with headache and hypertension to further reduce morbidity and mortality in this patient population.
Preeclampsia is a hypertensive disorder of pregnancy effecting ∼5–8% of pregnancies in the United States, and ∼8 million pregnancies worldwide. Preeclampsia is clinically diagnosed after the 20th week of gestation and is characterized by new onset hypertension accompanied by proteinuria and/or thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. This broad definition emphasizes the heterogeneity of the clinical presentation of preeclampsia, but also underscores the role of the microvascular beds, specifically the renal, cerebral, and hepatic circulations, in the pathophysiology of the disease. While the diagnostic criteria for preeclampsia relies on the development of de novo hypertension and accompanying clinical symptoms after 20-week gestation, it is likely that subclinical dysfunction of the maternal microvascular beds occurs in parallel and may even precede the development of overt cardiovascular symptoms in these women. However, little is known about the physiology of the non-reproductive maternal microvascular beds during preeclampsia, and the mechanism(s) mediating microvascular dysfunction during preeclamptic pregnancy are largely unexplored in humans despite their integral role in the pathophysiology of the disease. Therefore, the purpose of this review is to provide a summary of the existing literature on maternal microvascular dysfunction during preeclamptic pregnancy by reviewing the functional evidence in humans, highlighting potential mechanisms, and providing recommendations for future work in this area.
