Subarachnoid Hemorrhage and Posterior Reversible Encephalopathy in Eclampsia

Posterior Reversible Encephalopathy Syndrome (PRES) is thought to occur when there is a sudden elevation in blood pressure that surpasses the autoregulatory capacity of the cerebral vasculature. This condition leads to endothelial dysfunction, resulting in the breakdown of the blood brain barrier and the development of vasogenic edema. A 26-year-old nulliparous woman at 30 weeks of gestation presented to the emergency department with severe headache and seizures. Blood pressure monitoring showed 200/110 mmHg, prompting an emergency cesarean section due to suspected eclampsia. After ultrasound measurements indicated early fetal growth restriction consistent with 27 weeks, a 1000 g female infant (<1 percentile) with Apgar scores of 5 and 7 was delivered under general anesthesia. MRI revealed a subarachnoid hemorrhage and findings consistent with posterior reversible encephalopathy syndrome. The patient received antihypertensive and antiepileptic treatment in the Intensive Care Unit. In a subsequent pregnancy 11 months later, she underwent cesarean delivery at 34 weeks due to preterm labor, delivering a 2550 g male infant with Apgar scores of 7 and 8. No recurrence of PRES was observed. This case highlights the potential for reversible progression of PRES and subarachnoid hemorrhage during pregnancy with timely diagnosis and appropriate management.

Keywords: Posterior reversible encephalopathy syndrome (PRES), subarachnoid hemorrhage (SAH), cerebral edema, eclampsia, maternal neurological complications