A case of Posterior Reversible Encephalopathy Syndrome Presenting as Generalized Seizure after Delivery

ABSTRACT

Posterior reversible encephalopathy syndrome (PRES) is typically characterized by headache, altered mental functioning, seizure, and visual loss associated with imaging findings of bilateral subcortical and cortical edema with a predominantly posterior distribution. The usual causes of PRES are hypertensive encephalopathy, preeclampsia, eclampsia, cyclosporine A neurotoxicity and uremic encephalopathy. Early recognition of PRES is important because the treatment of PRES can be relatively contraindicated in some conditions, such as cerebral ischemia. We describe a 28-year-old woman who presented with a seizure 11 days after delivery. The diagnosis of PRES was made later. To make an early diagnosis of PRES, the emergency physician should include PRES in the differential diagnosis and consider an MRI with diffusion-weighted imaging in patients presenting with seizure, altered mental status, headache, and visual loss, especially patients with a hypertensive crisis, an organ transplantation, or a history of recent delivery.