Abstract
Discussion Forum (0)
Introduction:
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Introduction:
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Posterior Reversible Encephalopathy Syndrome (PRES) in Pregnancy
Dr. Victoria Conniff
Abstract
Discussion Forum (0)
Introduction:
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Introduction:
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
Posterior reversible encephalopathy syndrome (PRES) is a rare condition associated with hypertensive encephalopathy, eclampsia, and cytotoxic/immunosuppressant drug use. The pathogenesis is unclear but appears to be characterized by disordered cerebral autoregulation and endothelial dysfunction. Most commonly, PRES is characterized by headache, confusion, visual changes, seizures, and characteristic posterior cerebral white matter edema on imaging. The main component to management of PRES and/or hypertensive emergencies in pregnancy is expeditious antihypertensive therapy. Neuroimaging should not be delayed if a patient presents with neurologic symptoms.
Case:
A 23 year-old nullipara at 24 weeks gestation presented altered mental status, sudden onset bilateral vision loss, severe headache, nausea and vomiting. On presentation, she was noted to have severely elevated blood pressures. Head imaging abnormality in the posterior parietal and occipital lobes bilaterally consistent with PRES. Her lab abnormalities included elevated creatinine, transaminitis, and thrombocytopenia. Patient received IV antihypertensives, IV magnesium therapy for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturity. Infant was delivered via primary low transverse cesarean. Patient had resolution of visual loss within the first 24 hours after admission. She had resolution of lab abnormalities and blood pressure normalized by post-partum day 3.
Discussion: PRES is defined as an association of neurologic symptoms with abnormalities on head imaging. A relationship between preeclampsia/eclampsia and PRES are described in the literature due to their similar clinical findings. The clinical challenge is that PRES in obstetrical patients will go undiagnosed. Prompt recognition and treatment is important in preventing permanent damage.
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