Reversible posterior leukoencephalopathy syndrome accompanying HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome

Abstract

A case of reversible posterior leukoencephalopathy syndrome (RPLS) accompanying HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is reported. A 39-year-old woman with no pregnancy-induced hypertension, attended our hospital because of acute epigastralgia at 22 weeks' gestation. One hour after arrival, she developed seizures complicated by HELLP syndrome. We performed an emergency cesarean section and admitted her to the ICU. On the first postoperative day, anisocoria was observed. A head CT showed cerebral edema. We initiated therapy with glycerol and magnesium, and maintained normothermia. A head MRI showed high signal intensity lesions in the white matter of the bilateral frontal and occipital lobes on T2-weighted and FLAIR images. We diagnosed RPLS. An magnetic resonance angiography (MRA) showed vasospasm at the cerebral arteries. She made good progress and moved to the obstetrics ward on postoperative day 15. Follow-up MRI and MRA revealed that the hyperintensity lesions on T2-weighted and FLAIR images had disappeared and the vasospasm was improved.