Persistent Vegetative State Following a Cardiac Arrest in a Patient With Preeclampsia and Posterior Reversible Encephalopathy Syndrome: A Case Report

Abstract

We report the case of a 35-year-old female patient who presented to a tertiary referral hospital in a persistent vegetative state (PVS) following a cardiac arrest that occurred approximately one hour after an elective cesarean delivery for a postterm pregnancy complicated by preeclampsia. Magnetic resonance imaging (MRI) of the brain performed seven days after the cardiac arrest showed findings consistent with posterior reversible encephalopathy syndrome (PRES). Following transfer to our hospital, the patient was carefully evaluated, stabilized, and successfully weaned off mechanical ventilation. However, due to the lack of neurological recovery, the decision was made to transfer her to a neurorehabilitation center for further management. This case report explores the potential link between PRES and PVS.

Keywords: cardiac arrest; case report; persistent vegetative state; posterior reversible encephalopathy syndrome; preeclampsia.

Figure 1. An MRI of the brain (axial) demonstrating bilateral fronto-parieto-occipital cortical and subcortical changes consistent with posterior reversible encephalopathy syndrome (yellow arrows).

(A, B) Apparent diffusion coefficient (ADC) maps showing restricted diffusion in the white matter; (C, D) Corresponding bright signals on diffusion-weighted imaging (DWI); (E, F) Fluid-attenuated inversion recovery (FLAIR) images; (G, H) T2-weighted imaging (T2WI) revealing bilateral hyperintense cortical lesions; (I) Contrast-enhanced T1-weighted imaging (T1W C+) showing no postcontrast enhancement; the cortex appears diffusely expanded bilaterally, with no notable changes in the cerebellum, thalamus, basal ganglia, or brainstem.