Posterior reversible encephalopathy syndrome (PRES), pre-eclampsia and emergency caesarean section.

Posterior reversible encephalopathy syndrome (PRES), pre-eclampsia and emergency caesarean section.

Published: 27 Nov 2017

© Anaesthesia Cases / 2017-0231 / ISSN 2396-8397

Authors

Dr James Cuell [1]
Dr Joanna Marriott [2]
Dr Jaime Greenwood [2]
  • [1] Specialist Registrar, Anaesthetics, Birmingham School of Anaesthesia, Birmingham, United Kingdom
  • [2] Consultant, Anaesthetics, Worcester Royal Hospital, Worcester, United Kingdom

Summary

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with numerous clinical signs that may evolve rapidly and persist for weeks [1]. Diagnosis is confirmed with characteristic vasogenic cerebral oedema on cranial MRI [2]. 

Hypertension in pregnancy, notably pre-eclampsia and eclampsia are a major contributor to maternal mortality and morbidity [3]. The condition of PRES is often, but not always, associated with hypertension, yet it is not commonly within the list of differential diagnoses for hypertensive patients in pregnancy [4].

We describe the case of a 25-year-old female patient presenting at term, requiring an emergency caesarean section under spinal anaesthesia that was converted to a general anaesthetic following an acute, sudden onset headache. She had no maternal hypertension or pre-eclampsia and no relevant past medical history. After a subsequent uneventful post-partum period she was discharged home, but was readmitted to hospital a few days later following a seizure and was subsequently diagnosed with PRES. 

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