Unusual Presentation of Posterior Reversible Encephalopathy Syndrome After Spinal Anesthesia for Cesarean Section: A Case Report

Background: Headache after spinal anesthesia (SA) is usually attributed to post dural puncture headache (PDPH). We report a case of posterior reversible encephalopathy syndrome (PRES) after spinal anesthesia to a normotensive pregnant patient presented for cesarean section (CS). Case presentation: A 33-year-old pregnant woman underwent a CS under SA. The patient was obese, had gestational diabetes mellitus with a history of two spontaneous abortions and had a history of one uneventful CS. Immediately after the SA, the patient developed an acute severe headache relieved with medical treatment. The patient complained after 8 hours postoperatively of headache, sudden blurred vision which was followed by a generalized tonic-clonic seizure treated by intravenous midazolam and magnesium sulfate. The headache and visual disturbance resolved completely one hour later. The MRI suggested the diagnosis of PRES. Conclusion: We hereby contribute to the literature an uncommon neurological disorder, the PRES, occurred in a normotensive parturient. Key words: Posterior reversible encephalopathy syndrome, headache, pre-eclampsia, eclampsia, spinal anesthesia, post dural puncture headache.