Posterior Reversible Encephalopathy Syndrome and Pre-eclampsia/Eclampsia: Anesthetic Implications and Management

Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic disorder that has recently become more frequently diagnosed. While the exact etiology of PRES remains unclear, multiple diseases are associated with PRES. Moreover, there is increasing recognition of the association of PRES in pre-eclampsia/eclampsia with advancements in imaging techniques and increased awareness of the disorder. While pre-eclampsia/eclampsia alone presents unique perioperative challenges, PRES further complicates anesthetic management. Unfortunately, the anesthetic management for these critically ill and complex patients is not well elucidated and it is unclear whether the anesthetic choice may actually worsen neurologic symptoms. We describe two different presentations of PRES with pre-eclampsia/eclampsia, their anesthetic implications, and management.