A case of severe posterior reversible encephalopathy syndrome in a preeclamptic woman in the early postpartum period

抄録

Posterior reversible encephalopathy syndrome (PRES) presents with headaches, an altered mental status, seizures and visual loss, and generally exhibits a good prognosis. We herein report the case of a primiparous preeclamptic woman who developed severe PRES after cesarean delivery at term. She underwent emergency cesarean section due to the onset of HELLP syndrome at 37 weeks of gestation. She fell into a deep trance on the first day postpartum. Brain MRI showed diffuse brain edema involving the brainstem. Due to the considerable risk of brain herniation, we performed surgical decompression for brain swelling on that day in addition to intensive treatment for HELLP syndrome and DIC. The patient successfully recovered from the acute episode without any neurological deficits. Although most cases of PRES involve a good prognosis without the need for surgical intervention, physicians should keep in mind the potential for serious cases requiring decompressive brain surgery in women with PRES.