POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN PREGNANCY- A CASE REPORT
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 30
Abstract
CLINICAL PRESENTATION A 23 year old primi referred at 34 weeks gestation with history of elevated blood pressure reading of 160/100mmHg. She was having regular ante-natal checkups and was diagnosed to be a Gestational Diabetic on insulin and Pregnancy Induced Hypertension on 2 drugs, (Labetalol and Methyl-DOPA). On admission, she was well-oriented, pulse rate 100/minute, respiratory rate 20/minute, afebrile, blood pressure 160/100 mmHg. Bilateral pitting pedal oedema of grade II was noted. Obstetric Examination Singleton Pregnancy corresponding to gestational age, cephalic presentation, relaxed feel. Next morning, she developed severe headache not responding to medication, flashes of light and blurring of vision. She was treated with general supportive measures and 4 grams of Injection Magnesium sulphate was loaded IV along with 1 gram per hour infusion to prevent seizures. NST was nonreactive and there was evidence of deteriorating renal function by laboratory parameters. Emergency Caesarean section was done under General anaesthesia in view of impending eclampsia, unfavourable cervix and preterm premature rupture of membranes. An unasphyxiated male baby of weight 3075 grams which cried soon after birth was handed over to the neonatologist for preterm care. Maternal ascites was noted. The patient was stable during the operation. Intraoperative hypertension was controlled with IV Labetalol .On shifting her to SICU, she was disoriented, irritable and complained of acute loss of vision following which she developed generalized tonic clonic convulsions. BP recording was 170/120 mmHg and was on Magsulph infusion for 36 hrs. She was desaturating despite supplemental oxygen and elective ventilation done in view of recurrent seizures. BP was controlled and serial lab data were normal in postpartum Period. Vision improved within 4 days with complete recovery of vision. She was discharged home on day 8 and was off hypertensive medications. Fundoscopy was normal. CT Head showed abnormal patchy ill-defined hypodensities involving bilateral occipitoparietal subcortical white matter and basal ganglia. MRI Head, Figures (1) and (2) revealed areas of high signal throughout the white matter involving the parietal regions and bilaterally to involve occipital and temporal lobes suggestive of PRES.
Authors and Affiliations
Heera Shenoy T.
Keywords
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- EP ID EP570047
- DOI 10.18410/jebmh/2018/467
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