Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Eclampsia

 

Síndrome de encefalopatía posterior reversible atípico en paciente gestante. Atypical posterior reversible encephalopathy syndrome in a pregnant patient.

Introduction: Posterior reversible encephalopathy syndrome (PRES) was first described by Hinchey in 1996, when he observed that some patients presented with an acute reversible picture comprising mental alterations, loss of vision and headache.

Objective: To present the clinical case of a patient with atypical posterior reversible encephalopathy syndrome.

Clinical case: A 19-year-old woman, 36.5 weeks of gestation, presented with a clinical picture of 4 hours of evolution with high intensity stabbing pain in the epigastrium associated with moderate intensity global headache, accompanied by a self-resolved convulsive episode. Magnetic resonance imaging (MRI) showed bilateral intensity changes in the frontoparietal cortico-subcortical regions, lenticular nuclei and brain stem region with restrictive pattern in some lesions, and diffusion was indicative of ischemic vascular involvement with diffuse edema, in addition, parietooccipital paramedial hemorrhagic foci were observed bilaterally, suggesting a possible PRES.

Conclusions: PRES should be considered as a diagnosis in a previously healthy pregnant woman who has sudden convulsive episodes during labor. The exact etiology of PRES during pregnancy is not entirely clear and remains controversial. Clinical presentation and MRI are used for diagnosis. Immediate treatment should be focused on controlling the underlying cause or pathology, the main one being hypertension. 

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Encefalopatía Posterior Reversible en el Contexto de la Eclampsia. Reporte de Caso y Revisión de la Literatura. Reversible Posterior Encephalopathy In The Context Of Eclampsia. Case Report And Review Of Literature.

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder characterized by headaches, visual disturbances, altered level of consciousness, seizures, and a variety of neurological deficits that are caused by a severe increase in blood pressure. Hypertensive disorders of pregnancy, mainly preeclampsia and eclampsia, continue to be one of the main causes of morbidity and mortality during pregnancy worldwide, causing neurological complications ranging from singular seizures to the development of status epilepticus and the advent of potentially fatal cerebrovascular events. We describe the presentation of posterior reversible encephalopathy syndrome in a pregnant adolescent who developed a hypertensive disorder of pregnancy.

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