Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia.


OBJECTIVE We sought to investigate the concurrence of posterior reversible encephalopathy syndrome (PRES) with eclampsia and to describe the obstetric, radiological, and critical care correlates. STUDY DESIGN This was a single-center, 2001-2010 retrospective cohort study of all patients with eclampsia who underwent neuroimaging via magnetic resonance imaging (MRI) or computerized tomography (CT) with or without contrast. RESULTS Forty-six of 47 of eclamptic patients (97.9%) revealed PRES on neuroimaging using 1 or more modalities: MRI without contrast, 41 (87.2%); MRI with contrast, 27 (57.4%); CT without contrast, 16 (34%); CT with contrast, 7 (14.8%); and/or magnetic resonance angiography/magnetic resonance venography, 2 (4.3%). PRES was identified within the parietal, occipital, frontal, temporal, and basal ganglia/brainstem/cerebellum areas of the brain. Eclampsia occurred antepartum in 23 patients and postpartum in 24 patients. Headache was the most common presenting symptom (87.2%) followed by altered mental status (51.1%), visual disturbances (34%), and nausea/vomiting (19.1%). Severe systolic hypertension was present in 22 patients (47%). CONCLUSION The common finding of PRES in patients with eclampsia suggests that PRES is a core component of the pathogenesis of eclampsia. Therapy targeted at prevention or reversal of PRES pathogenesis may prevent or facilitate recovery from eclampsia.

DOI: 10.1016/j.ajog.2013.02.015

Cite this paper

@article{Brewer2013PosteriorRE, title={Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia.}, author={Justin M Brewer and Michelle Y. Owens and Kedra L Wallace and Amanda A Reeves and Rachael Morris and Majid Khan and Babbette LaMarca and James N. Martin}, journal={American journal of obstetrics and gynecology}, year={2013}, volume={208 6}, pages={468.e1-6} }