Posterior Reversible Encephalopathy Syndrome in pre-eclampsia presenting as Anton syndrome

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological entity caused by reversible ischemia most commonly of the posterior cerebral vasculature. Diagnosis ofPRES might be obscured when the patient presents with visual anasognosia (Anton syndrome) as the initial manifestation.

Case report: An 18 year old lady presented with vomiting, severe headache and oedema at 32 weeks gestation. She had severe-preeclampsia evidenced by blood pressure of 160/110mmHg, hyperreflexia and albuminuria. She further had visual anasognosia (cortical blindness) and a post-partum convulsion prompting the consideration of PRES, which was later confirmed by Magnetic Resonance imaging. She underwent immediate delivery by caesarean section followed by rapid reduction of blood pressure resulting in complete recovery within 48 hours.

Conclusion: Prompt recognition of Posterior Reversible Encephalopathy Syndrome (PRES), which has a strong association with pre-eclampsia, is extremely important to prevent the associated morbidity and mortality. Eventhough, the vigilant management of PRES during ante-partum period might be complicated, this case consolidates the fact that early diagnosis of PRES leads to a favourable outcome.

DOI: http://dx.doi.org/10.4038/slja.v23i1.7636