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Posterior reversible encephalopathy syndrome in eclampsia.

Ravindra K Garg1, Neeraj Kumar1, Hardeep S Malhotra1

  • 1Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.

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|September 21, 2018
PubMed
Summary

Posterior reversible encephalopathy syndrome (PRES) is a serious complication of eclampsia, potentially affecting up to 100% of patients. Early recognition and prompt treatment of PRES in eclampsia are crucial for preventing long-term neurological damage.

Keywords:
Epilepsyhypertensive encephalopathymagnetic resonance imagingpregnancy

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Area of Science:

  • Neurology
  • Obstetrics
  • Radiology

Background:

  • Posterior reversible encephalopathy syndrome (PRES) presents with headache, visual disturbances, seizures, and altered mental status.
  • Neuroimaging in PRES often reveals cerebral edema, particularly in the parietal and occipital lobes.

Purpose of the Study:

  • To review the current understanding of posterior reversible encephalopathy syndrome (PRES) specifically in the context of eclampsia.
  • To consolidate knowledge on the pathophysiology, clinical presentation, and management of PRES in eclamptic patients.

Main Methods:

  • Literature search conducted across PubMed, Scopus, and Google Scholar databases.
  • Search terms included "eclampsia", "eclampsia and posterior reversible encephalopathy syndrome", and "pregnancy and posterior reversible encephalopathy syndrome".

Main Results:

  • Up to 100% of eclamptic patients may exhibit features of posterior reversible encephalopathy syndrome (PRES).
  • Pathophysiology is attributed to "vasogenic" and "vasospasm" mechanisms, with cerebral edema and hemorrhages as common autopsy findings.
  • While most clinical and imaging findings are reversible, some patients may experience permanent sequelae like vision loss.

Conclusions:

  • Posterior reversible encephalopathy syndrome (PRES) is a significant and potentially devastating complication of eclampsia.
  • Prompt management of hypertension and seizures, with magnesium sulfate as the preferred anticonvulsant, is key.
  • Early diagnosis and intervention are vital to mitigate the severe consequences of PRES in eclampsia.