P039: ATYPICAL CASE OF POSTERIOR REVERSIBLE ENCEPHALOPATHY IN A PREGNANT PATIENT WITHOUT PREECLAMPSIA
Marvi Qureshi, Medical Student1, Jeffrey Huang, MD2; 1University of Central Florida College of Medicine, 2Oak Hill Hospital
We report a 33-year-old G1 at 41 weeks who presented with seizures in the midst of labor with no prior history of eclampsia, hypertension, or seizures. The patient was transported for an emergency cesarean section under general anesthesia. The patient’s epidural placed prior to the seizure was discontinued. The patient was extubated post-delivery. Neurology was consulted to determine the cause of first-time seizures. CT and MRI revealed posterior reversible encephalopathy syndrome (PRES). It is important for obstetricians and anesthesiologists to consider this diagnosis in previously healthy patients who present with seizures during pregnancy, especially patients who do not have hypertension.
The obstetrician must always consider various diagnoses in a patient with a presentation other than what is typically expected, and as such management of a potential emergency must be an important consideration for the anesthesiologist also managing this patient. One rare potential obstetrical emergency is posterior reversible encephalopathy, which may manifest itself in a variety of ways. 1 This is a neurological disorder that is characterized by vasogenic edema that takes place in the parietal and occipital lobes usually presenting during parturition, which is when symptoms typically manifest14. The most prevalent and early symptoms include seizures, headaches, encephalopathy, visual disturbances, and coma1. Further consequences of this syndrome include autoimmune disorders, thrombocytopenic syndrome, renal failure, Henoch Schoenlein purpura, and hypertensive encephalopathy 1. Therefore, it is important to consider this differential in a patient presenting with initial symptoms which may be suggestive of this syndrome in order to prevent further associated disastrous consequences1. Common causes of this syndrome include pre-eclampsia and eclampsia, but patients who are initially normotensive and do not have proteinuria may also present with PRES, as in our patient14. We discuss a 33-year-old G1 with no prior history of seizures or hypertension presented with seizures an hour into labor. Her epidural catheter was discontinued and a stat cesarean section was performed under general anesthesia. She was diagnosed with posterior reversible encephalopathy post-delivery and followed up with neurology after the diagnosis was established. Written consent has been obtained from the patient for this case report.