Virginia Research Day 2025

Medical Resident Research Case Reports

15 Posterior Reversible Leukoencephalopathy Syndrome in a Woman with Eclampsia: Pressing the Need for Delivery

Authors: Jordan Nolan DO 1 ; Nistha Acharya, MD 2 ; Kimberly Bird MD 3 ; Fahid Alghanim, MD 4 Corresponding author: jordan.nolan@lpnt.net

1,2 Department of Internal Medicine, Sovah Health Danville, Virginia 3,4 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Sovah Health Danville, Virginia

was immediately given 6 g of magnesium IV, started on magnesium drip, and given 20 mg of IV labetalol due to severely elevated blood pressure. OB was present on arrival and performed a stat C-section in the emergency department. The patient had an area of ecchymosis on the right frontal area, so a head CT was ordered and showed no intracranial abnormalities. A brain MRI was then ordered and showed findings of acute punctate infarcts in bilateral cerebellar hemispheres with vasogenic edema in bilateral occipital lobes which is consistent with PRES syndrome. After fetal delivery and aggressive blood pressure control, the patient improved and was extubated. The patient’s neurological exam had returned to her baseline. Discussion: This case demonstrates the presence of vasogenic edema on brain MRI after seizure activity due to eclampsia. These MRI findings can be

transient with evidence of complete resolution seen in most cases if the inciting factor is reversed and blood pressure is adequately controlled. Eclampsia also pathologically develops from endothelial dysfunction showing that there could be a strong connection between eclamptic patients and PRES. Although most eclampsia patients do not undergo routine brain MRI screening, which limits the evidence of this connection. This case is unique since PRES occurred in a pregnant woman with eclampsia and completely resolved after delivery of the fetus. Conclusion: In summary, this case offers insight into PRES syndrome in pregnant women with eclampsia but demonstrates that it still requires much more exploration.

Introduction: Reversible Posterior Leukoencephalopathy Syndrome (PRES) is not clearly understood and can be a contradiction to its own name as it is not always located posteriorly, not always in the white matter, and most importantly not always reversible. PRES is typically caused by poor cerebral autoregulation and endothelial dysfunction. When the upper limits of normal for a patient’s blood pressure are reached, they are unable to autoregulate, and this leads to capillary leakage disrupting the blood-brain barrier allowing for axonal swelling and possible vasogenic edema. Case: A 26-year-old G1P1 Caucasian female, 36 weeks gestation, with a past medical history of Factor V Liden on chronic anticoagulation with Enoxaparin who presented to emergency room after having multiple episodes of seizure-like activity at home. The patient was postictal in the ED and decision was made to intubate for airway protection. The patient

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