A RARE CASE OF IMPENDING ECLAMPSIA WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME FOR EMERGENCY LSCS

Dr. Gayatri Khanvelkar; Dr. Mary Samuel; Dr. Adnan Qadri

Volume : VII, Issue : VII, July - 2017

A RARE CASE OF IMPENDING ECLAMPSIA WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME FOR EMERGENCY LSCS

Dr. Gayatri Khanvelkar, Dr. Mary Samuel, Dr. Adnan Qadri

Abstract :

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological syndrome associated with various clinical conditions, presenting with headache, encephalopathy, seizures, cortical visual disturbances or blindness. Imaging predominantly shows parieto–occipital white matter changes, with vasogenic oedema being the most accepted pathophysiology. We report a 22–year–old primigravida who presented in term pregnancy with seizures and blindness, scheduled for emergency caesarean section. She was managed peri–operatively under general anaesthesia and shifted to intensive care unit. Postoperative MRI ain revealed ill–defined hypointensine lesions in the bilateral parietio–occipital and bilateral fronto–parietal regions involving white matter in T2 and FLAIR and hypointensie lesions on T1W1, few foci of restricted diffusion noticed on DW1. Similar foci were noted on bilateral lentiform nuclei and adjoining posterior limb of the internal capsule. Both eyeballs showed hyperintense lesions in the posterior segment on the temporal side on FLAIR: retinal detachment due to haemorrhage in the retinal space, suggestive of PRES. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment. The importance of prompt suspicion and management in preventing short– and long–term neurological deficits in reversible condition like PRES is highlighted.