Case Report
Year 2021,
Volume: 43 Issue: 3, 297 - 302, 30.09.2021
Abstract
References
- 1. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. American Journal of Neuroradiology. 2008;(29):1036–42.
- 2. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. American Journal of Neuroradiology. 2008;(29):1043–49.
- 3. Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clinical Neurology and Neurosurgery. 2010;(112):886–89.
- 4. Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 2009;30:1371-9.
- 5. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494- 500.
- 6. Hugonnet E, Da Ines D, Boby H, Claise B, Petitcolin V, Lannareix V, Garcier JM. Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagn Interv Imaging 2013;94:45-52.
- 7. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Archives of neurology. 2008;(21):205–10.
- 8. Legriel S, Pico F, Azoulay E. Understanding posterior reversible encephalopathy syndrome. Annual Update in Intensive Care and Emergency Medicine.2011;(112):631-53.
- 9. Marra A, Vargas M, Striano P, Del Guercio L, Buonanno P, Servillo G. Posterior reversible encephalopathy syndrome: the endothelial hypotheses. Med Hypotheses 2014;82:619–22.
- 10. McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012;33:896-903.
- 11. McKinney AM, Short J, Truwit CL, Mc Kinney ZJ, Kozak OS, Santa Cruz KS, Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007;189:904-912.
- 12. Negro A, Zuccoli G, Regolisti G, Mastrangeli S, Rossi E. Reversible posterior leukoencephalopathy associated with postpartum HELLP syndrome. Eur J Intern Med 2005;16:291-293.
Two different neuroimaging patterns in two cases with eclampsia, HELLP syndrome and posterior reversible encephalopathy syndrome
Abstract
Introduction: Preeclampsia (PE) and eclampsia are two clinical conditions associated with pregnancy. In eclampsia, seizures also occur. One of the complications of eclampsia is HELLP syndrome, a condition characterized by hemolytic anemia, elevated liver enzymes and thrombocytopenia. Preeclampsia and eclampsia are both well-known risk factors for posterior reversible encephalopathy syndrome (PRES), a clinical-radiological syndrome characterized by variable combinations of neurological signs. In this syndrome, typical neuroimaging findings are bilateral symmetric hemispheric edema in parietooccipital regions. However, atypical imaging findings have also been described. Here, we report two different neuroimaging patterns in two cases with PRES associated with eclampsia and HELLP syndrome.
Case: Two pregnant female patients were admitted to our emergency department because of respiratory and neurological symptoms. While the medical history of one of the patients was unremarkable, the other patient was diagnosed with epilepsy and hypertension before pregnancy. Both of them had resistant increased blood pressure and seizures. They underwent urgent caesarean section. In the postoperative period, they were transferred into intensive care unit, necessitating mechanical ventilation because of respiratory failure. Laboratory findings were suggestive of eclampsia and HELLP syndrome and brain imaging findings were suggestive of PRES. Additionally, brain computed tomography scan of one of the patients showed subarachnoid haemorrhage and the magnetic resonance imaging scans of the other patient showed restricted diffusion, indicating cytotoxic edema. The patients were treated with blood transfusions and antihypertensive drugs. Maintenance of normotension resulted in neurological improvement. Subsequently, both of the patients were discharged without neurological sequela.
Discussion and Conclusion: In this article, we reported both the associations between HELLP syndrome, eclampsia and PRES, and two different neuroimaging patterns of PRES. Effective controlling of blood pressure and treatment of HELLP syndrome resulted in complete disappearance of the radiological findings and improvement in the neurological sings.
References
- 1. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. American Journal of Neuroradiology. 2008;(29):1036–42.
- 2. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. American Journal of Neuroradiology. 2008;(29):1043–49.
- 3. Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clinical Neurology and Neurosurgery. 2010;(112):886–89.
- 4. Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 2009;30:1371-9.
- 5. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494- 500.
- 6. Hugonnet E, Da Ines D, Boby H, Claise B, Petitcolin V, Lannareix V, Garcier JM. Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagn Interv Imaging 2013;94:45-52.
- 7. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Archives of neurology. 2008;(21):205–10.
- 8. Legriel S, Pico F, Azoulay E. Understanding posterior reversible encephalopathy syndrome. Annual Update in Intensive Care and Emergency Medicine.2011;(112):631-53.
- 9. Marra A, Vargas M, Striano P, Del Guercio L, Buonanno P, Servillo G. Posterior reversible encephalopathy syndrome: the endothelial hypotheses. Med Hypotheses 2014;82:619–22.
- 10. McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012;33:896-903.
- 11. McKinney AM, Short J, Truwit CL, Mc Kinney ZJ, Kozak OS, Santa Cruz KS, Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007;189:904-912.
- 12. Negro A, Zuccoli G, Regolisti G, Mastrangeli S, Rossi E. Reversible posterior leukoencephalopathy associated with postpartum HELLP syndrome. Eur J Intern Med 2005;16:291-293.
There are 12 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | September 30, 2021 |
| Acceptance Date | September 27, 2021 |
| Published in Issue | Year 2021Volume: 43 Issue: 3 |