Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia

Abstract

Rationale: Eclampsia, an obstetric emergency frequently seen in pregnant or puerperal women, is a risk factor for posterior reversible encephalopathy syndrome (PRES). Most cases of eclampsia occur postpartum. We report a woman with PRES associated with eclampsia 10 weeks post-delivery, the latest onset ever reported. Patient concerns: A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES. Diagnosis: The patient was diagnosed as PRES associated with eclampsia. Interventions: The patient received levetiracetam and edaravone. Outcomes: Her clinical course was uneventful and she fully recovered without neurological complications Lessons: The possible diagnosis of late onset postpartum eclampsia, even weeks post-delivery, should be considered, since initiation of early treatment averts severe complications and decreases mortality. Sharing our experience may increase awareness of PRES induced by late-onset postpartum eclampsia.