Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia: A case report

Abstract

Rationale: Eclampsia, an obstetric emergency frequently seen in pregnant or puerperal women, is a risk factor for posterior reversible encephalopathy syndrome (PRES). Most cases of eclampsia occur postpartum. We report a woman with PRES associated with eclampsia 10 weeks post-delivery, the latest onset ever reported.

Patient concerns: A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES.

Diagnosis: The patient was diagnosed as PRES associated with eclampsia.

Interventions: The patient received levetiracetam and edaravone.

Outcomes: Her clinical course was uneventful and she fully recovered without neurological complications LESSONS:: The possible diagnosis of late onset postpartum eclampsia, even weeks post-delivery, should be considered, since initiation of early treatment averts severe complications and decreases mortality. Sharing our experience may increase awareness of PRES induced by late-onset postpartum eclampsia.

Figure 1

Radiographical findings on admission day. MRI axial T2-weighted FLAIR (A), DWI (B), and ADC mapping (C) demonstrated high-density areas in the parieto-occipital and frontal lobes. ADC = apparent diffusion coefficient, DWI = diffusion-weighted magnetic resonance imaging, FLAIR = fluid-attenuated inversion recovery, MRI = magnetic resonance imaging.

Figure 2

One month after admission. MRI axial T2-weighted FLAIR (A), DWI (B), and ADC mapping (C) showed complete remission of the foci. ADC = apparent diffusion coefficient, DWI = diffusion-weighted magnetic resonance imaging, FLAIR = fluid-attenuated inversion recovery, MRI = magnetic resonance imaging.