Posterior reversible encephalopathy associated with eclampsia and HELLP syndrome

Abstract

Posterior reversible encephalopathy (PRES) is a rare clinical entity which presents with neurological signs and symptoms with characteristic findings on neuroimaging. Eclampsia is a common pre-disposing cause. We report a case of a 29-year-old lady presenting at 36 weeks of gestation with eclampsia evident by a very high blood pressure, generalized tonic clonic (GTC) seizures, albuminuria and clonus. She remained drowsy with a fluctuating Glasgow coma scale (GCS) post-delivery with features of HELLP syndrome, prompting the need for neuroimaging which confirmed PRES. Early normal vaginal delivery (NVD), with aggressive blood pressure and seizure control resulted in a complete recovery within 72 hours post-partum. In a pregnant patient with eclamptic seizures, a high degree of suspicion is needed, and neuroimaging should be utilized in order to diagnose PRES. This case highlights the fact that PRES is a reversible entity with favourable outcomes with timely recognition and aggressive management.