Posterior reversible leukoencephalopathy syndrome (PRES) associated with severe eclampsia: Clinical and biochemical features

Objectives: Posterior Reversible Encephalopathy Syndrome (PRES) and eclampsia share clinical characteristics and patients may present with a combination of these two entities. Our aim was to study the proportion of patients with eclampsia having evidence of PRES in their brain imaging. Methods: Retrospective study of pregnant patients diagnosed as having eclampsia that underwent brain magnetic resonance imaging (MRI) during their hospitalization. MRI diagnosis of PRES was assessed by 2 investigators blinded to group. Results: We included a total of 29 patients with eclampsia, out of which 17 (58.6%) had MRI evidence of PRES. When patients with eclampsia and eclampsia/PRES were compared, there was no difference in demographic characteristics such as age, weight or multiparity. Patients with eclampsia/PRES had higher levels of creatinine, liver enzymes, mean platelet volume and there was a trend towards higher proteinuria. Infants of mothers with eclampsia/PRES also had worse 1 min APGAR scores. Conclusion: PRES appears to accompany eclampsia in over half of all cases. The clinical picture of patients with eclampsia with or without associated PRES is similar, but certain biochemical characteristics suggest that PRES might be indicative of a more severe disease process. (C) 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.