Delayed Post-partum Eclampsia or PRES: An Enigmatic Connection in Maternal Health
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition that is identified by headache, seizures, vomiting and nausea as well as distorted vision and in many cases blindness. It mainly affects women specifically females with eclampsia. Our study throws light on assessing cases of PRES diagnosed in postpartum eclampsia with 48 hours after delivery occurrence being described as late postpartum. What specific pathophysiological processes and risk factors lead to the onset of posterior reversible encephalopathy syndrome (PRES) in cases of postpartum eclampsia, and what role does early diagnosis and intervention play in increasing maternal survival? A literature review was conducted after comprehensive search from PubMed and Google Scholar from 2013 to 2024. Finally, 12 studies were taken for analyzing. Occurrence of PRES in the age group 20-35 with headache was most common (33%) and preeclampsia history (83.3%) was another key feature. Seizure was identified in 75% and PRES was diagnosed in some cases without seizures through MRI. PRES was developed in six post-partum cases post caesarean. Treatment consisted of MgSO4 alone given to 50% cases and MgSO4 with phenytoin given to 25% of cases. Even though medical professionals might be familiar with risk factors of eclampsia and its symptoms, they should also be aware of PRES development in patients with eclampsia. Headache has been identified as one the key drivers and crucial symptom. An early implementation of MRI is vital for timely diagnosis of PRES.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Jayakrishnan K S, Sarathlal S, Babu Rajendra Prasad T R, Hariharan A, Jamila Hameed
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
[1] Gupte S, Wagh G. Preeclampsia–eclampsia. The Journal of Obstetrics and Gynecology of India. 2014 Feb;64:4-13.
[2] Sudulagunta SR, Sodalagunta MB, Kumbhat M, Settikere Nataraju A. Posterior reversible encephalopathy syndrome(PRES). Oxf Med Case Reports. 2017 Apr 3;2017(4):omx011. doi: 10.1093/omcr/omx011. PMID: 28473920; PMCID: PMC5410886.
[3] Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Eng J Med 1996; 334(8):494–500
[4] Demirel İ, Kavak BS, Özer AB, Bayar MK, Erhan ÖL. An intensive care approach to posterior reversible encephalopathy syndrome (PRES): An analysis of 7 cases. Journal of the Turkish German Gynecological Association. 2014;15(4):217.
[5] Zeeman GG, Hatab M, Twickler DM. Maternal cerebral blood f low changes in pregnancy. Am J Obstet Gynecol 2003;189:968 72.
[6] Roth C, Ferbert A. Posterior reversible encephalopathy syndrome: is there a difference between pregnant and non-pregnant patients? Eur Neurol 2009; 62:142–48.
[7] Mai H, Liang Z, Chen Z, Liu Z, Xu Y, Chen Xl, et al. MRI characteristics of brain edema in preeclampsia/eclampsia patients with posterior reversible encephalopathy syndrome. BMC pregnancy and childbirth. 2021 Dec;21:1-8.
[8] Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
[9] D’Amico S, Bodin P, Delpech M, Noteborn R. Prisma. InDistributed space missions for earth system monitoring 2012 Aug 18 (pp. 599-637). New York, NY: Springer New York.
[10] Youssoufa M, Callixte KT, Christian N. Occipital lobe epilepsy secondary to Posterior Reversible Encephalopathy Syndrome (PRES) during a post-partum eclampsia in Mali (West Africa). BMC Research Notes. 2013 Dec;6:1-4.
[11] Ural ÜM, Balik G, Şentürk Ş, Üstüner I, Çobanoğlu U, Şahin FK. Posterior reversible encephalopathy syndrome in a postpartum preeclamptic woman without seizure. Case reports in obstetrics and gynecology. 2014;2014(1):657903.
[12] Jain PG, Bhargav M, Jain A. Post partum convulsion: pres or eclampsia. Indian J Obstet Gynecol Res. 2015 Apr;2(2):120-2.
[13] Makarim AH, Karunarathna SM. Posterior reversible encephalopathy syndrome in postpartum woman: a case report. Sri Lanka Journal of Obstetrics and Gynaecology. 2016 Aug 19;38(1).
[14] Mirzamoradi M, Hosseini MS, Saleh M, Esmaeili S. Posterior reversible encephalopathy syndrome (PRES) associated with eclampsia: a case study. IJMRHS. 2017 Jan 1;6(3):48-53.
[15] Sesar A, Cavar I, Sesar AP, Sesar I. Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia. Taiwan Journal of Ophthalmology. 2018 Apr 1;8(2):111-4.
[16] Masai K, Ueda Y, Naito H, Tsukahara K, Aokage T, Fujisaki N, et al. Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia: A case report. Medicine. 2019 Apr 1;98(16):e15187.
[17] Majumder A, Akter KT, Ronald Gomes R. Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient with Late Postpartum with Probable SLE. J Neurol Forecast. 2020; 3 (1).;1006.
[18] Rasendrakumar N, Gunaseelan L, Muthyala SS, Meenakshisomasundaram M, Sharma N. Postpartum Eclampsia Complicated with Posterior Reversible Encephalopathy Syndrome. Cureus. 2021 Dec;13(12).
[19] Nishad S, Ahmad A, Gupta U, Srivastava S. DELAYED PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN POSTPARTUM PERIOD. Era's Journal of Medical Research. 2022 Jul 1;9(2):286-7.
[20] Zhu M, Huang H. Posterior reversible encephalopathy syndrome in a patient with late postpartum eclampsia. Medicine. 2023 Nov 10;102(45):e35867.
[21] Vuong AD, Pham XT, Nguyen PN. Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review. International Journal of Emergency Medicine. 2024 Sep 9;17(1):118.
[22] Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AM J Nueroradiol 2008; 29(6):1036-42.
[23] Bahadur A, Mundhra R, Singh R, Mishra J, Suresh G, Jaiswal S, et al. Predictors of Posterior Reversible Encephalopathy Syndrome (PRES) in Women with Pre-eclampsia/Eclampsia: A Retrospective Analysis. Cureus. 2022 Nov 13;14(11):e31459. doi: 10.7759/cureus.31459. PMID: 36523680; PMCID: PMC9747669.
[24] Verma AK, Garg RK, Pradeep Y, Malhotra HS, Rizvi I, Kumar N, et al. Posterior encephalopathy syndrome in women with eclampsia: Predictors and outcome. Pregnancy Hypertens. 2017 Oct; 10:74-82. doi: 10.1016/j.preghy.2017.06.004. Epub 2017 Jun 8. PMID: 29153695.
[25] Chen Z, Zhang G, Lerner A, Wang AH, Gao B, Liu J. Risk factors for poor outcome in posterior reversible encephalopathy syndrome: systematic review and meta-analysis. Quantitative Imaging in Medicine and Surgery. 2018 May;8(4):421.
[26] Bembalgi S, Kamate V, Shruthi KR. A Study of Eclampsia Cases Associated with Posterior Reversible Encephalopathy Syndrome. J Clin Diagn Res. 2015 Jul;9(7):QC05-7. doi: 10.7860/JCDR/2015/14039.6276. Epub 2015 Jun 16. PMID: 26393169; PMCID: PMC4573001.
[27] Fisher N, Saraf S, Egbert N, Hamel P, Stein EG, Minkoff H. Clinical correlates of posterior reversible encepha lopathy syndrome in pregnancy. J Clin Hypertens 2016; 18(6):522–27.
[28] Gewirtz AN, Gao V, Parauda SC, Robbins MS. Posterior Reversible Encephalopathy Syndrome. Curr Pain Headache Rep. 2021 Feb 25;25(3):19. doi: 10.1007/s11916-020-00932-1. PMID: 33630183; PMCID: PMC7905767.
[29] Banayan JM. Postpartum Preeclampsia-A Diagnosis Not to Be Missed. Journal of Cardiothoracic and Vascular Anesthesia. 2023 Jun 1;37(6):1039-41.
[30] Parasher A, Jhamb R. Posterior reversible encephalopathy syndrome (PRES): presentation, diagnosis and treatment. Postgraduate medical journal. 2020 Oct;96(1140):623-8.
[31] Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.
[32] Javed N, Naseem S, Amer Awan M, Siddique SK, Ahmad A. Posterior reversible encephalopathy syndrome (pres) presenting as transient complete visual Loss. Pakistan Journal of Neurological Sciences (PJNS). 2019;14(1):42-4.
[33] Chao AS, Chen YL, Chang YL, Chao A, Su SY, Wang TH. Severe pre-eclamptic women with headache: is posterior reversible encephalopathy syndrome an associated concurrent finding?. BMC Pregnancy and Childbirth. 2020 Dec;20:1-8.
[34] Servillo G, Bifulco F, De Robertis E, Piazza O, Striano P, Tortora F, et al. Posterior reversible encephalopathy syndrome in intensive care medicine. Intensive Care Med. 2007 Feb;33(2):230-6. doi: 10.1007/s00134-006-0459-0. Epub 2006 Nov 21. PMID: 17119920.
[35] Fang X, Wang H, Liu Z, Chen J, Tan H, Liang Y, et al. Posterior reversible encephalopathy syndrome in preeclampsia and eclampsia: The role of hypomagnesemia. Seizure. 2020 Jan 7;76:12-16. doi: 10.1016/j.seizure.2020.01.003. Epub ahead of print. PMID: 31945641.
[36] Kaur G, Ashraf I, Peck MM, Maram R, Mohamed A, Crespo DO, et al. Chemotherapy and immunosuppressant therapy-induced posterior reversible encephalopathy syndrome. Cureus. 2020 Oct;12(10).
[37] Hosapatna Basavarajappa D, Saha PK, Bagga R, Khandelwal N, Modi M. Neuroradiological perspectives of severe preeclampsia and eclampsia spectrum - Correlation from posterior reversible encephalopathy syndrome. Pregnancy Hypertens. 2020 Apr; 20:119-123. doi: 10.1016/j.preghy.2020.04.003. Epub 2020 Apr 7. PMID: 32283331.
[38] Pilato F, Distefano M, Calandrelli R. Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome: Clinical and Radiological Considerations. Front Neurol. 2020 Feb 14;11:34. doi: 10.3389/fneur.2020.00034. PMID: 32117007; PMCID: PMC7033494.
[39] Striano P, Striano S, Servillo G, Bifulco F, Tortora F, Caranci F, et al. Posterior reversible encephalopathy syndrome and spinal epidural haematoma in a hypertensive patient. Eur J Anaesthesiol. 2007 Dec;24(12):1065-7. doi: 10.1017/s0265021507000993. PMID: 18210662.
[40] Vázquez-Rodríguez JG, Salas-Magaña MT, Serrano-Rodríguez J. Incidence and clinical manifestations of posterior reversible encephalopathy syndrome (PRES) in patients with eclampsia. 2017-2021 Data from a High Specialty Medical Unit, Mexico City. International Journal of Research and Reports in Gynaecology. 2022 Jul 28;5(3):90-7.
[41] Jia L, Zhang H. Comment on “Posterior reversible encephalopathy syndrome in preeclampsia and eclampsia: The role of hypomagnesemia”. Seizure-European Journal of Epilepsy. 2020 May 1;78:172-3.