SEVERE POSTPARTUM PREECLAMPSIA COMPLICATED WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES): DIAGNOSTIC CHALLENGE AND MULTIDISCIPLINARY MANAGEMENT
Keywords:
postpartum preeclampsia; postpartum hypertension; PRES; postpartum headache; magnetic resonance imaging; magnesium sulfateAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0875
Abstract
Background: Delayed-onset postpartum preeclampsia may occur after obstetric discharge and can initially present with headache, visual symptoms, or nonspecific neurological complaints. Posterior reversible encephalopathy syndrome (PRES) is a potentially severe neuro-obstetric complication that requires integrated clinical and neuroradiological assessment. Case Report: We describe an academic case of a 29-year-old woman, six days after cesarean delivery, without chronic hypertension, who presented with severe occipital headache, blurred vision, photopsia, and progressive drowsiness. Admission blood pressure was 178/112 mmHg, with hyperreflexia, peripheral edema, and significant proteinuria. Laboratory findings showed mild thrombocytopenia, elevated liver enzymes, and a urine protein/creatinine ratio of 0.74 mg/mg. Brain computed tomography excluded acute hemorrhage, whereas magnetic resonance imaging revealed bilateral parieto-occipital FLAIR hyperintensities consistent with vasogenic edema. Severe postpartum preeclampsia complicated by PRES was diagnosed. The patient received magnesium sulfate, intravenous antihypertensive therapy, and intensive care monitoring, with gradual clinical improvement and radiological resolution during follow-up. Conclusion: Persistent postpartum headache associated with severe hypertension should be treated as a neuro-obstetric emergency. Early recognition of PRES and coordinated multidisciplinary management can reduce the risk of seizures, stroke, neurological sequelae, and maternal death.
Keywords: postpartum preeclampsia; postpartum hypertension; PRES; postpartum headache; magnetic resonance imaging; magnesium sulfate.
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References
American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260. doi:10.1097/AOG.0000000000003891.
Hauspurg A, Jeyabalan A. Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2022;226(2S):S1211-S1221. doi:10.1016/j.ajog.2020.10.027.
Alliance for Innovation on Maternal Health. Obstetric Emergency Readiness Resource Kit: Severe Hypertension in Pregnancy and Postpartum. 2023.
Bernstein PS, Martin JN Jr, Barton JR, Shields LE, Druzin ML, Scavone BM, et al. National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. Obstet Gynecol. 2017;130(2):347-357. doi:10.1097/AOG.0000000000002115.
Triplett JD, Kutlubaev MA, Kermode AG, Hardy T. Posterior reversible encephalopathy syndrome (PRES): diagnosis and management. Pract Neurol. 2022;22(3):183-189. doi:10.1136/practneurol-2021-003194.
Zelaya JE, Al-Khoury L. Posterior Reversible Encephalopathy Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated 2026 Jan 31.
Tawati DA, Chan WS. A systematic review of posterior reversible encephalopathy syndrome in pregnant women with severe preeclampsia and eclampsia. Obstet Med. 2023;16(4):236-241. doi:10.1177/1753495X221150302.
Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427-432. doi:10.4065/mcp.2009.0590.
Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494-500. doi:10.1056/NEJM199602223340803.
Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017;264(8):1608-1616. doi:10.1007/s00415-016-8377-8.
Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy syndrome: a truly treatable neurologic illness. Perit Dial Int. 2012;32(6):590-594. doi:10.3747/pdi.2012.00152.
Magley M, Hinson MR. Eclampsia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated 2024.
Countouris M, et al. Hypertension in Pregnancy and Postpartum. Circulation. 2025. doi:10.1161/CIRCULATIONAHA.124.073302.
Agency for Healthcare Research and Quality. Management of Postpartum Hypertensive Disorders of Pregnancy. Comparative Effectiveness Review. Rockville (MD): AHRQ; 2023.
Karrar SA, Martingano DJ, Hong PL. Preeclampsia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated 2024.
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