Permanent visual deficits secondary to the HELLP syndrome

Area of Science:

• Obstetrics and Gynecology
• Neurology
• Hematology

Background:

• Preeclampsia and eclampsia are serious pregnancy complications.
• Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a severe variant often associated with preeclampsia/eclampsia.
• Visual disturbances are common in preeclampsia/eclampsia but typically reversible.

Observation:

• A 34-year-old woman with eclampsia and HELLP syndrome experienced multiple organ system failures including encephalopathy, cardiomyopathy, pulmonary edema, liver failure, and disseminated intravascular coagulation (DIC).
• The patient developed retinal hemorrhages and a left occipital lobe hemorrhagic infarct.
• These neurological and ocular findings resulted in permanent right homonymous hemianopia and severely reduced visual acuity in the left eye.

Findings:

• Unlike most cases where visual deficits resolve, this patient sustained permanent visual impairment.
• The superimposition of HELLP syndrome on eclampsia appeared to contribute to more severe and lasting neurological damage.
• This case underscores the potential for severe, irreversible neurological sequelae in complicated pregnancies.

Implications:

• Clinicians must maintain a high index of suspicion for HELLP syndrome in patients with severe preeclampsia or eclampsia.
• Prompt and aggressive management of HELLP syndrome is essential to mitigate risks of severe maternal morbidity, including permanent neurological deficits.
• Further research into the pathophysiology and optimal management strategies for HELLP syndrome is warranted to improve patient outcomes.