Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome complicated with HELLP syndrome: a case report

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  • KONISHI Hiromi
    Department of Perinatology and Gynecology, Hirakata Municipal Hospital
  • TABUKI Kunio
    Department of Perinatology and Gynecology, Hirakata Municipal Hospital
  • KATO Ayaka
    Department of Perinatology and Gynecology, Hirakata Municipal Hospital
  • HATTORI Tomoko
    Department of Perinatology and Gynecology, Hirakata Municipal Hospital
  • KOBAYASHI Masanao
    Department of Emergency and Critical Care, Hirakata Municipal Hospital
  • NAGANO Yuzo
    Department of Neurosurgery, Hirakata Municipal Hospital
  • OKAZAKI Tadashi
    Department of Perinatology and Gynecology, Hirakata Municipal Hospital

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Other Title
  • HELLP症候群に合併した後方可逆性脳症症候群および可逆性脳血管攣縮症候群
  • 症例報告 HELLP症候群に合併した後方可逆性脳症症候群および可逆性脳血管攣縮症候群
  • ショウレイ ホウコク HELLP ショウコウグン ニ ガッペイ シタ コウホウ カギャクセイ ノウショウ ショウコウグン オヨビ カギャクセイ ノウ ケッカン レンシュク ショウコウグン

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Abstract

<p>Between posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS), there are similar clinical features and images. We experienced a case that had a diagnosis of PRES and RCVS complicated with HELLP syndrome by magnetic resonance imaging. She was 35-year-old with gravida 4 para 3. At 40 weeks pregnant, she came to the hospital because of diarrhea for two days and epigastric pain. After 155 minutes, she had thunderclap headache and after 215 minutes, she had tonic convulsions. The blood test suggested HELLP syndrome (T-bil 0.89 mg/dl, LDH 1788 IU/l, AST 699 IU/l, Plt 85000 /mm3). Computed tomography showed the subarachnoid hemorrhage (high absorbance in the left sylvian fissure, right high fornix of the frontal lobe, and fissure interhemispheric). We performed cesarean section under general anesthesia for maternal safety first. We gave a diagnosis of PRES just after the operation because magnetic resonance angiography (MRI) showed high-signal foci in the cortex and subcortical of left caudate nucleus, bilateral putamen, and bilateral occipital lobe in FLAIR. We also suspected RCVS on day three after operation because MR angiography showed multifocal vasoconstrictions toward bilateral anterior and middle cerebral arteries. On day seven after operation, the high-signal foci were reduced, and the multifocal vasoconstrictions were improved. On day 21 after operation, her general condition became better and left the hospital with though she complained of mild headache and defect of memory. [Adv Obstet Gynecol, 69 (3) : 269-276, 2017 (H29.8)]</p>

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