Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicoradiological syndrome1 with multifactorial risk factors like preeclampsia and eclampsia. It should be considered in all pregnant and postpartum females having neurological signs and symptoms along with radiological features. Early diagnosis and management is vital in this reversible condition.2
We report a 26-year-old multipara female who presented to our hospital after 5 hours of normal vaginal delivery (NVD) with seizures, accelerated hypertension, occipital headache, and blurred vision. She was initially managed with Inj. Magnesium 2 gm, Midazolam 1 mg and was eventually referred to our hospital. There were no similar past history during last pregnancy and medical history of any chronic illnesses was negative.
Her GCS was15/15, reacting pupils, heart rate 120/ min, blood pressure 180/100 mm of Hg, oxygen saturation of 94% at room air with mild tachypnea 27/ min and complained of feeling of nausea. Apart from bilateral pitting oedema other systemic examinations were unremarkable. Laboratory reports showed mild proteinuria and hypoalbuminemia (serum albumin 2.2 gm/ dl). MRI brain showed prominent white matter oedema of bilateral occipital, posterior temporal region without any evidence of bleeding.
Immediate ICU management in consultation with neurology team included administration of magnesium and labetalol infusion, mannitol, frusemide, levetiracetam along with close monitoring of vitals/ GCS.
The aim was to lower the blood pressure gradually over the next 24 hours with labetalol and furosemide infusions. Once her condition stabilized, magnesium was stopped, and injectables were replaced with oral amlodipine, levetiracetum and torsemide. By day three she recovered completely from visual disturbances and was shifted out of ICU.