Virginia Research Day 2025

Medical Resident Research Case Reports

25 Posterior Reversible Encephalopathy Syndrome Due to Post-Partum Eclampsia

Sheba John, DO; Fatima-Guzman-Gawel, MD Corresponding author: sheba.john@lpnt.net

Sovah Health Family Medicine Residency, Danville, VA

hypertensive emergency. An EEG was normal, and an MRI revealed fluid signal in the bilateral parietal and occipital lobes, suggestive of PRES. Following treatment of eclampsia and resolution of symptoms, the patient was continued on Keppra (500 mg twice daily) for seizure prophylaxis. She was advised to follow up with neurology in 4–6 weeks for potential tapering of medication. Discussion: PRES is commonly associated with uncontrolled hypertension, especially when systolic BP exceeds 160 mmHg. Other causes include preeclampsia, renal failure, liver disease, autoimmune disorders, and sepsis. The pathophysiology of PRES involves dysregulation of cerebral autoregulation, leading to breakdown of the blood-brain barrier and vasogenic edema. The posterior circulation is most often affected due to less adaptive mechanisms to

handle increased blood pressure. MRI typically shows bilateral, symmetric hyperintensities in the parieto occipital regions. Though PRES is generally reversible, some cases result in permanent deficits. Early recognition of preeclampsia/eclampsia symptoms and prompt intervention can help prevent complications like PRES. In our patient, the acute phase was managed with Keppra, and long-term anticonvulsant therapy was not required after resolution of the underlying etiology. Conclusion: This case underscores the importance of recognizing PRES in postpartum eclampsia patients with neurological symptoms. Early diagnosis, treatment of the underlying condition, and appropriate seizure management can lead to favorable outcomes. Vigilance and timely intervention are crucial to prevent complications like PRES.

Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological disorder caused by various underlying conditions, including uncontrolled hypertension, preeclampsia, renal disease, autoimmune disorders, and cytotoxic drugs. Symptoms, which develop within hours to days, include altered mentation, seizures, visual disturbances, and headaches. This case highlights a young postpartum female who developed PRES following postpartum eclampsia. Case Presentation: A 36-year-old female, G5P3023, presented on postpartum day 11 following a normal vaginal delivery. She was admitted after a prolonged postictal state requiring intubation. On examination, she was sedated, intubated, and responsive to verbal commands. CT head and CT pulmonary embolism (PE) studies were negative. She was treated with IV magnesium sulfate for postpartum eclampsia and antihypertensive agents for

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2025 Research Recognition Day