POSTPARTUM ATYPICAL POSTERIOR REVERSIBLE ENCEPHALOPHATHY SYNDROME, DIAGNOSTIC CHALLENGES: A CASE REPORT

Dr. Shreya Mishra*, Dr. Mamta Mahajan

ABSTRACT

Seizures in pregnant women are often linked to eclampsia, but in 12% of cases, other pathology of cerebral origin may be the cause such as PRES syndrome. The clinical case that we report highlights an atypical PRES syndrome occurring in postpartum patient. Atypical PRES presents with variations in clinical features, imaging patterns, or course of recovery making its diagnosis challenging. Here we report a case of 25 year old woman with no medical history, who had undergone C section for fetal distress and developed generalised tonic clonic seizures on day six of post-operative day at home. She had no records of previous high blood pressure or any neurological manifestations. After initial examination a brain CT scan was performed which failed to identify any abnormalities suggestive of PRES. Subsequently, MRI revealed focal T2/FLAIR, hyperintensity in subcortical region of right high frontal lobe with no diffusion restriction, likely indicating vasogenic edema. She was managed in ICU with magnesium sulphate, levitaracetam and mannitol. There was a complete remission in three days and she was discharged on tablet levitaracetam. The mechanism of genesis of PRES is still based on the hypothesis not yet confirmed. Understanding the atypical presentation of PRES is crucial for early diagnosis and appropriate management, ensuring better outcome despite its potential complexities.

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