Posterior reversible encephalopathy syndrome with ischemic infarction complicated with intrauterine fetal death A case report

Rationale: Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD). Patient concerns: A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria. Diagnosis: PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia. Interventions: The patient received levetiracetam and valproate for seizure management. Outcomes: Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission. Lessons: PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.