Seule la première patiente a présenté un épisode convulsif. Preeclampsia/HELLP syndrome, immunosuppressive/cytotoxic drugs, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, acute or chronic renal diseases, steroid therapy, and liver failure seem to be the causes of the onset of edema [4]. It was described first by Hinchey et al. In total, we included 40 qualifying studies, with a final population of 47 patients, in our analysis (Figure 3) [7–46]. Though peripartum posterior reversible encephalopathy syndrome is well recognized, its atypical variant with hemorrhage is uncommon. in 1996 [1]. (2021). Vital parameters were monitored every 15 min. We revealed an increasing in two of three cases of PRES: in one patient the elevated LDH level is associated with thrombocytopenia, elevated liver enzymes, and increasing in markers of hemolysis and first depended on the developing of HELLP syndrome in a preeclamptic woman; meanwhile the other patients showed an isolated increasing in LDH level that could be linked to the developing of PRES, as reported in other cases in literature [59]. Posterior reversible encephalopathy syndrome From Wikipedia, the free encyclopedia Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is a rare condition in which parts of the brain are affected by swelling, usually as a result of an underlying cause. Hydrocephalus and Posterior Reversible Encephalopathy Syndrome (PRES) are under-diagnosed conditions in peri-partum period. The term PRES can be a misnomer as the syndrome can involve or extend beyond the posterior cerebrum. At the time of admission to hospital, her blood pressure was 140/90 mmHg and laboratory tests were normal, except ATIII 56% that was treated with infusion of 2000 UI of ATIII. A. Fawole, “Posterior reversible encephalopathy syndrome in a adult female,”, R. K. Garg, H. S. Malhotra, T. B. Patil, and A. Agrawal, “Cerebral-autoregulatory dysfunction syndrome,”, V. H. Lee, E. F. M. Wijdicks, E. M. Manno, and A. Serum examinations were normal, excepted for an isolated increasing of LDH: 876 U/L. The brain MR-imaging and MR-angiography of the circle of Willis were performed which showed cortical and subcortical hyperintense lesions in both cerebellar lobes with elevated diffusion and no angiopathy, imaging features related to vasogenic edema consistent with PRES syndrome (Figure 1) [7]. MATERIALS AND METHODS: Retrospective assessment of 151 patients with PRES was performed, … It should not be confused with chronic hypertensive ence… Early and late complication such as pulmonary edema, dissection of extracranial internal left carotid artery, cerebral herniation, short term memory loss, subarachnoid hemorrhage, permanent mild dysmetria, visual impairment, and death have been described [9, 19, 24, 36]. An early diagnosis is primary in order to start therapy and avoid mortality and morbidity in terms of long and short temp complications. In the analysis of cerebral lesion and in order to obtain a right diagnosis it is useful perform an accurate MRI examination using Apparent Diffusion Coefficient (ADC) maps and Diffusion Weighted Imaging. CASE REPORT Encephalopathy in COVID-19 has been widely reported with several reports of posterior reversible encephalopathy syndrome (PRES) speculated to be due to an abrupt surge in blood pressure caused by coronavirus disease. CNS: central nervous system, MV: mechanic ventilation, ICU: intensive care unit, MRI: magnetic resonance imaging, CT: computed tomography, CTA: computed tomographic angiographic; Multidrug: therapy including antiepileptic, antihypertensive, and other kind of drugs such as diuretics or antiplatelets or anticoagulants, and ELICA: extracranial internal left carotid artery. suggest defining this condition as potentially RES, to emphasise that the posterior localization of the lesions, even if constant, may not represent the most relevant finding in some patients and that reversibility is not spontaneous but is usually related to an adequate treatment [6]. Laboratory tests reported increased liver enzymes (AST = 222 U/L, ALT = 170 U/L, CPK = 266 U/L, and LDH = 678 U/L) and a reduction in platelet count to 56 x 109/L; serum bilirubin was 2,8 g/l, ATIII 47, and albumin 2,2 g/dL. Maternal characteristics and clinical data were extracted. Axial FLAIR magnetic resonance images demonstrated bioccipital foci of high signal intensity involving the cortex and subcortical white matter. Tonic-clonic seizure occurred during early postpartum in a woman with … PRES syndrome should always be considered in women with acute hypertension disorders associated with epileptic seizures or other neurological symptoms during pregnancy and in the postpartum. This syndrome is manifested by neurologic symptoms: headache, nausea or vomiting, generalized seizures, visual disturbance, and altered sensorium whereby the vasogenic edema of the subcortical white matter occurrs in the posterior occipital and parietal lobes [2]. In postpartum day 6 she had an improvement in symptoms, but suddenly in postpartum day 7 she developed hypertension and a generalized tonic-clonic seizure treated with Diazepam iv 10 mg. After seizure the patient underwent to neuroprophylaxis with magnesium sulfate, a close anesthesiologic monitoring, and to a cerebral MRI. compared 24 patients with preeclampsia-eclampsia associated PRES and 72 patients with PRES of other predisposing causes and in the first group showed frequent complete resolution of edema and less frequent residual structural lesions [51]. Blood gas analysis showed a severe acidosis (pH: 7.26; BE: -10,5). Parieto-occipital white matter changes due to vasogenic oedema can be observed on imaging modalities. Review of the cases included in the literature. For this reason monitoring LDH serum level as marker of endothelial dysfunction could be useful [59]. The resolution further supported the diagnosis of PRES [7]. There was no past history of hypertension nor other diseases except Gilbert’s syndrome. The follow-up brain MRI performed 3 weeks later showed the complete resolution of brain oedema and no vascular imaging of abnormalities. Postpartum angiopathy (PPA), a rare cause of stroke in the puerperium, is heralded by severe headaches within 1–2 weeks after delivery. In this case, we will focus on the posterior reversible encephalopathy syndrome (PRES) which is sometimes also seen in PE and eclampsia. We then analyzed the timing of onset of PRES, instrumental diagnosis, drug therapy, patient outcome, and clinical and instrumental follow-up for each patient. When we used the keywords “PRES in post-partum” we obtained 64 results. For what concern medical treatment 9/47 patients were treated only with antiepileptic prophylactic or therapeutic drug (magnesium sulfate, benzodiazepines, gardenale, levetiracetam, and valproate), 4/47 only with antihypertensive drug (calcium channel blockers, angiotensin receptor blockers, nitroderivates, beta receptors blockers, and diuretics), 23/47 with a combined antiepileptic and antihypertensive therapy, and 10/47 receiving a multidrug treatment including additional drugs (such as steroids, Acetylsalicylic Acid, Low Molecular Weight Heparin, Propofol, Paracetamol, and Codeine); finally one patient was treated with multidrug therapy associated with Plasma Exchange. postpartum, she presented a decreased right visual acuity; subsequently one episode of sei-zure followed by partial loss of vision in the right eye. Blood pressure was normal at admission and there were no alteration in serologic examination. A. Rabinstein, “Clinical spectrum of reversible posterior leukoencephalopathy syndrome,”, A. R. Pande, K. Ando, R. Ishikura et al., “Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study,”, S. Yoon, B. Cho, S. Oh, S. Park, I. Jang, and J. Lee, “Clinical and Radiological Spectrum of Posterior Reversible Encephalopathy Syndrome,”, T. Okada, M. Kanagaki, A. Yamamoto, Y. Fushimi, and K. Togashi, “Magnetic resonance imaging of vascular encephalopathy related to pregnancy,”, I. R. Postma, S. Slager, H. P. H. Kremer, J. C. De Groot, and G. G. Zeeman, “Long-term consequences of the posterior reversible encephalopathy syndrome in eclampsia and preeclampsia: A review of the obstetric and nonobstetric literature,”, I. Demirel, B. S. Kavak, A. Copyright © 2019 Eleonora Marcoccia et al. The initial evaluation of patients with PRES should focus on a rapid correction of blood pressure, hydration using crystalloid fluids, and maintenance of adequate oxygenation [14]. PRES is most commonly associated with hypertensive encephalopathy, preeclampsia-eclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and immunosuppressive/cytotoxic drugs. Instrumental diagnosis was obtained only by CT in 2/47, only by MRI in 25/47, by CT and MRI in 19/47, and by CT, MRI, and CTA in 1/47 patients. Subjective cognitive problems, development of chronic epilepsy, and progress to irreversible (partial) blindness can be long-time consequences after years from acute episode [51]. Cortical blindness is considered a typical and characteristic symptom of this syndrome [18]. Approaching a woman suffering from headache after CS or a VD with intrapartum epidural a close monitoring is necessary in order to have a quick intervention in case of development of PRES. It is also described as a complication after chemotherapy, infection, sepsis, autoimmune diseases, and hypercalcemia (cytotoxic edema) [1]. Forty-five patients reported other symptoms. An ulterior MRI pattern to evaluate is the presence of an increased leptomeningeal enhancement in Fluid Attenuated Inverse Recovery (FLAIR) sequence in these patients [56]. A. Edlow, L. R. Caplan, K. O'Brien, and C. D. Tibbles, “Diagnosis of acute neurological emergencies in pregnant and post-partum women,”, S. O. Casey, R. C. Sampaio, E. Michel, and C. L. Truwit, “Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions,”, C. Lamy, C. Oppenheim, J. F. Méder, and J. L. Mas, “Neuroimaging in posterior reversible encephalopathy syndrome,”, M. C. Narbone, R. Musolino, F. Granata, I. Mazzù, M. Abbate, and E. Ferlazzo, “PRES: Posterior or potentially reversible encephalopathy syndrome?”, M. Cozzolino, C. Bianchi, G. Mariani, L. Marchi, M. Fambrini, and F. Mecacci, “Therapy and differential diagnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum,”, P. Zis and A. Tavernarakis, “Headache and Status Epilepticus in the Postpartum Period; Posterior Reversible Encephalopathy Syndrome or Cerebral Venous Thrombosis?”, E. K. Orehek, J. D. Burns, F. Koyfman, R. J. Azocar, J. W. Holsapple, and D. M. Green, “Postpartum trifecta: simultaneous eclamptic intracerebral hemorrhage, PRES, and herniation due to intracranial hypotension,”, R. Kauntia, R. Valsalan, S. Seshadri, V. Pandit, and M. Prabhu, “Late postpartum preeclampsia with posterior reversible encephalopathy syndrome,”, B. K. Aygün, Y. Baykuş, S. Berilgen, B. Kavak, H. Çelik, and B. Gürateş, “Posterior reversible encephalopathy syndrome in severe preeclampsia: case report and literature review,”, W.-X. Nowadays the hypothesis of endothelial dysfunction in the pathophysiology of PRES is also proposed. No ophthalmological and neurological permanent damage persisted after 1-year follow-up. Agarwal e al. We reported three cases of PRES developed during puerperium, in which timely recognizing of patient’s symptoms reached us to perform an early diagnosis and sudden therapy. Angiography demonstrates segmental vasoconstriction that often resolves spontaneously. Shi F(1), Shen L, Shi Y, Shi L, Yang X, Jin Z, Liu W, Wu D. Author information: (1)Department of Neurology, Shanghai Fifth People's Hospital Affiliated to Fudan University, Shanghai, China. B. Wolfson, “Postpartum focal neurologic deficits: posterior leukoencephalopathy syndrome,”, G. Servillo, F. Bifulco, E. De Robertis et al., “Posterior reversible encephalopathy syndrome in intensive care medicine,”, V. S. Patil, “Posterior Reversible Encephalopathy Syndrome in Early Postpartum Women: A Case Report,”, G. Maggi, V. A. Lombana, E. Marcos, A. D. Ruiz Huerta, E. G. Arévalo, and F. G. Rodríguez, “Posterior leukoencephalopathy syndrome: Postpartum focal neurologic deficits: A report of three cases and review of the literature,”, M. A. Babahabib, I. Abdillahi, F. Kassidi, J. Kouach, D. Moussaoui, and M. Dehayni, “Posterior reversible encephalopathy syndrome in patient of severe preeclampsia with hellp syndrome immediate postpartum,”, H. Doherty, S. Hameed, I. Ahmed, and I. F. Russell, “Post-dural puncture headache and posterior reversible encephalopathy syndrome: a misdiagnosis or co-presentation?”, M. L. Gimovsky, G. M. Guzman, K. L. Koscica, M. A. Nazir, and D. E. Ross, “Posterior reversible encephalopathy with late postpartum eclampsia and short-term memory loss: a case report,”, D. Papoutsis, N. El-Attabi, and A. Sizer, “Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: Case report,”, S. Ehtisham and H. A. Hashmi, “Posterior reversible encephalopathy syndrome,”, C. Gómez-González, P. Rubio-Murillo, J. González-Maestre, and J. Martín de Pablos, “Reversible posterior encephalopathy during pregnancy and/or puerperium in the Intensive Care unit,”, W. Kameda, H. Sakai, T. Kamiyama, H. Iwata, A. Okazaki, and Y. Miyakuni, “Difficult postpartum management of a patient complicated by severe PIH and prolonged PRES,”, G. W. Lawson, “Blindness after confinement,”, R. Lemmens, S. Smet, G. Wilms, P. Demaerel, and V. Thijs, “Postpartum RCVS and PRES with normal initial imaging findings,”, A. Negro, G. Zuccoli, G. Regolisti, S. Mastrangeli, and E. Rossi, “Reversible posterior leukoencephalopathy associated with postpartum HELLP syndrome,”, M. Pezzi, E. L. Piane, A. M. Giglio et al., “Posterior reversible encephalopathy syndrome in late postpartum eclampsia,”, T. S. Siddiqui, B. Irfan-ul-Haq Rehman, M. Kumar, and N. Iqbal, “Posterior reversible encephalopathy syndrome (PRES),”, A. Magnetic resonance images performed 7 days after the first examination. 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