Atypical Presentation of a Preeclamptic Patient With Severe Features and Auditory Hallucinations

The primary purpose of the case study was to investigate an unusual case of preeclampsia (PreE) with severe features accompanied by atypical posterior reversible encephalopathy syndrome (PRES) and auditory hallucinations in the setting of a medical history of bipolar affective disorder. A 41-year-old, G2 P0 A1, morbidly obese (pregnancy body mass index = 42.8 kg/m²) white woman with a history of bipolar affective disorder and no previous prenatal care presented to the emergency room with a hypertensive crisis (262/138 mmHg) and complaints of headaches and visual changes for the past four days. Signs of proteinuria (dipstick reading: 3+) and renal insufficiency (creatinine: 1.9 mg/dL) were observed upon admission. Due to these factors, an urgent low transverse Cesarean section was performed. On post-operative day one, the patient continued to present with high blood pressure despite anti-hypertensive medications. Additionally, she reported auditory hallucinations, polyuria, blurry vision, and vomiting. A head computed tomography (CT) scan and magnetic resonance imaging (MRI) without contrast presented an atypical presentation of PRES with brainstem abnormalities and prominent white matter involvement found uniquely in the temporal lobes and bilateral hippocampal gyri. An additional hypertensive crisis (196/126 mmHg) occurred on post-operative day four, which was controlled with hydralazine. This case study highlights the need for close monitoring of patients with bipolar disorder and adequate prenatal care to avoid the adverse effects seen in hypertensive disorders of pregnancy. Additionally, the relationship between uncontrolled bipolar disorder and auditory hallucinations is explored.