Posterior reversible encephalopathy syndrome (PRES) showing different CT or MR findings and clinical courses : a report of four cases with pregnancy

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  • OGAWA Kenji
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • KAWA Motohiro
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • ISHIBASHI Satoko
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • SUGIURA Atsushi
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • HIRANO Hitoshi
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • TOYODA Shinji
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • ITANI Yoshio
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital
  • KITA Tsunekazu
    Department of Obstetrics and Gynecology, Nara Prefectural Nara Hospital

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Other Title
  • 異なる画像所見,臨床経過を示したposterior reversible encephalopathy syndrome（PRES）合併妊娠の4症例
  • 症例報告 異なる画像所見,臨床経過を示したposterior reversible encephalopathy syndrome (PRES)合併妊娠の4症例
  • ショウレイ ホウコク コトナル ガゾウ ショケン,リンショウ ケイカ オ シメシタ posterior reversible encephalopathy syndrome (PRES)ガッペイ ニンシン ノ 4 ショウレイ

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Abstract

Posterior reversible encephalopathy syndrome (PRES) comprises clinical and radiological findings with rapid onset. Patients experience hypertension, seizures, headache, visual disturbance. Four cases with PRES were treated in our hospital during the past two years, and were analyzed retrospectively from clinical charts. The age of onset in each case is 29, 27, 41, and 23 years old. All of them were primiparous. The gestational age at delivery was 28, 39, 33, and 39 weeks. All of them underwent emergent Cesarean section. The type/ severity of pregnancy-induced hypertension syndrome in each case were early onset/ severe hypertension with proteinuria, not onset, late onset/ severe hypertension with proteinuria, and late onset/ mild hypertension. Onset of eclampsia in each case was recognized during pregnancy, at delivery, never, and at delivery. Onset of HELLP syndrome was suspected in the third case. Neurological symptom in each case was mild visual disturbance, not recognized, visual disturbance, and involuntary movement. The edematous lesions in each case were the occipital lobe, and the occipital lobe, basal ganglia, and the parietal lobe, frontal lobe, temporal lobe, occipital lobe , basal ganglia , thalamus , and the parietal lobe, occipital lobe, basal ganglia. Each case needed 11, 10, 27, and 16 days for recovery. In these four cases with PRES, neurological symptom and onset of eclampsia were not associated with edematous lesions of brain. However in the case that edematous lesions were more extensive, it needed more time for recovery. In order to elucidate the relationship of clinical symptoms and radiographic findings, it is necessary to build the cases further in the future. [ Adv Obstet Gynecol, 66 (1) : 50-55, 2014 (H26.2)]

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