125 PRES a discussion with Graeme

Obsgynaecritcare

You are called to a code blue on the postnatal ward. A 28 yr old female who is 1 day post a non elective caesarean section has just had a witnessed convulsion lasting 1-2 min. She has now regained consciousness but seems a little confused and is complaining that she “has lost vision in both of her eyes”. Her BP is 180/100, and all other vital signs are normal.

What is this most likely to be? What is your differential diagnosis (what things do you not want to miss)? What investigations would you like done?

This turns out to be an episode of eclampsia and PRES (posterior reversible encephalopathy syndrome).

What is PRES? What are it’s radiological features and what is the mechanism which leads to this disorder?

Join Graeme and I as we discuss this uncommon but fascinating condition.

References

Gewirtz AN, Gao V, Parauda SC, Robbins MS. Posterior Reversible Encephalopathy Syndrome. Curr Pain Headache Rep. 2021 Feb 25;25(3):19. doi: 10.1007/s11916-020-00932-1. PMID: 33630183; PMCID: PMC7905767.

Marcoccia E, Piccioni MG, Schiavi MC, Colagiovanni V, Zannini I, Musella A, Visentin VS, Vena F, Masselli G, Monti M, Perrone G, Panici PB, Brunelli R. Postpartum Posterior Reversible Encephalopathy Syndrome (PRES): Three Case Reports and Literature Review. Case Rep Obstet Gynecol. 2019 Jan 27;2019:9527632. doi: 10.1155/2019/9527632. PMID: 30809401; PMCID: PMC6369475.