Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

11 POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) AT 33 WEEKS GESTATION

Lekha Kuchampudi, DO, PGY3; Christopher Marengo, MD Corresponding author: lekha.kuchampudi@lpnt.net

Sovah Health - Danville, Danville, Virginia

later confirmed PRES. In the ICU patient was initiated on IV Nicardipine drip for the elevated pressures, along with IV magnesium for eclampsia. During her treatment on the Nicardipine drip, she had improving blood pressures, and waxing and waning mentation. Patient became more alert and back to her baseline. She was resumed on her home seizure medications and required increased doses of her home blood pressure medications with strict ER precautions provided. Discussion: Methods: A targeted literature review was conducted using PubMed and Google Scholar with the search terms "eclampsia", "pre eclampsia, "encephalopathy", and "posterior reversible encephalopathy syndrome". PRES and Eclampsia share overlapping clinical presentation, including severe headaches, vision changes, and altered mental status. Both PRES and Eclampsia can and may start with uncontrolled hypertension. PRES rooted from eclampsia is typically reversible, however delayed diagnosis and treatment can lead to ischemia, hemorrhage or permanent neurological deficits. MRI remains the gold standard for diagnosis, as it allows for differentiating PRES from other causes of neurological conditions.

Background: Eclampsia is defined as hypertensive emergency in pregnant females that is differentiated from Pre-Eclampsia with the onset of seizures. Eclampsia can trigger several neurological conditions, such as Posterior Reversible Encephalopathy Syndrome (PRES). PRES is characterized by cerebral edema, and often is reversible if root cause is treated. Undiagnosed and/or untreated PRES syndrome can lead to long-term neurological damage. Case Report: 28 YO G1 presented at 33+1 weeks gestation presents to the hospital via EMS. She has a past medical history of epilepsy and hypertension with poor compliance. As reported by first responders, patient was found collapsed in a grocery store. Blood pressure on arrival was 230/150. Patient was immediately taken for a C-section under general anesthesia. Infant required transfer to tertiary care facility. Patient, however, was unstable for transfer and was sent to the intensive care unit, where she remained intubated. CT Head was obtained and showed new bilateral occipital and parietal white matter and cortical hypodensities with additional new left frontal subcortical hypodensities noted. Findings were concerning for PRES. MRI was later obtained, which

Conclusion: The above case demonstrated how uncontrolled hypertension can lead to significant problems for mother and baby during a pregnancy. It is vital that patients with hypertension, especially during pregnancy, are closely monitored by providers in the outpatient setting. Early imaging and early intervention and management of both blood pressure and seizure control are cricial for the best chances of recovery. Proper communication and teamwork between the outpatient provider, inpatient obstetric team, as well as the critical care unit were also essential in improving this patients overall well being. Diagnosis: Posterior Reversible Encephalopathy Syndrome (PRES) presenting at 33+1 weeks gestation.

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142 Edward Via College of Osteopathic Medicine (VCOM)