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An intensive care approach to posterior reversible encephalopathy syndrome (PRES): An analysis of 7 cases
İsmail Demirel1, Burçin Salih Kavak2, Ayşe B Özer1
1Department of Anesthesiology and Reanimation, Fırat University Faculty of Medicine, Elazığ, Turkey.
Insights
Posterior reversible encephalopathy syndrome (PRES) in obstetrics patients often presents with eclampsia or preeclampsia. Early diagnosis and treatment with antihypertensives, magnesium sulfate, and thiopental infusion can improve outcomes.
Area of Science:
- Obstetrics
- Neurology
- Intensive Care Medicine
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition often linked to pregnancy and the postpartum period.
- It has a multifactorial etiology and can present with diverse clinical and radiological findings.
Purpose of the Study:
- To retrospectively evaluate intensive care unit (ICU) treatments for obstetrics patients diagnosed with PRES.
- To assess the effectiveness of various therapeutic interventions in managing PRES during pregnancy and postpartum.
Main Methods:
- Retrospective review of 7 obstetrics patients diagnosed with PRES between July 2011 and July 2013.
- Evaluation of clinical data, pre- and post-treatment brain MRI, and neuropsychological tests.
Main Results:
- PRES was associated with eclampsia (5/7), severe preeclampsia (1/7), and HELLP syndrome (1/7).
- Treatments included calcium channel blockers, beta-blockers, magnesium sulfate, and sodium thiopental for sedation and convulsions.
- All patients showed improvement in neurological and radiological findings following ICU treatment.
Conclusions:
- PRES is a serious condition that can occur during pregnancy and postpartum, potentially leading to irreversible deficits or death.
- Early diagnosis and prompt treatment, including antihypertensives, magnesium sulfate, and potentially early thiopental infusion, are crucial for effective recovery.
- Supplementing standard treatment with early thiopental infusion is suggested for severe cases.
Objective:
The aim of this study was to retrospectively evaluate the intensive care unit treatments applied to obstetrics patients with a diagnosis of posterior reversible encephalopathy syndrome (PRES).
Material And Methods:
The cases of 7 pregnant patients who had been diagnosed with PRES between July 2011 and July 2013 were retrospectively reviewed. The patients' clinical data, brain magnetic resonance imaging (MRI) images before and after treatment, and neuropsychological tests were evaluated.
Results:
Five out of 7 patients had eclampsia, 1 patient had severe preeclampsia, and 1 patient developed HELLP syndrome secondary to PRES. Calcium channel blockers and β-blockers were used as antihypertensive treatment. All patients were treated with parenteral magnesium sulfate. In addition, sodium thiopental was given to control sedation and convulsions in all patients except 1. The neurological and radiological findings of all cases treated in the intensive care unit improved.
Conclusion:
Posterior reversible encephalopathy syndrome is a clinical condition with a multifactorial etiology and can result in different clinical findings. Radiological imaging techniques can be used for the diagnosis of PRES. Pregnancy and the postpartum period often lead to this syndrome. In some cases, PRES can cause irreversible neurological deficits or death. For patients with severe radiological findings, early diagnosis and thiopental infusion, in addition to treatment with antihypertensive agents and magnesium sulfate, may lead to quicker and more effective recovery from clinical manifestations. We suggest supplementation of standard treatment with early thiopental infusion.
