Posterior reversible encephalopathy syndrome (PRES) with bilateral tonic pupils, vitreous haemorrhage and chorioretinopathy secondary to HELLP syndrome

Visual disturbances in pregnancy can be highly variable and range from mild symptoms of photopsia, transient blurring of vision, field defects and rarely total blindness. Pre-eclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are all complications of pregnancy. Both PRES and HELLP are associated with visual loss and share common pathogenic mechanisms, such as the breakdown of the endothelial blood-brain barrier in PRES or the blood-retinal barrier in HELLP. We report a case of HELLP syndrome who presented with PRES with bilateral tonic pupils, vitreous haemorrhage and chorioretinopathy leading to bilateral blindness. Timely diagnosis with early supportive treatment resulted in the improvement to near-normal vision. This single case describes four different mechanisms of vision loss in the case of HELLP syndrome, that is, PRES along with bilateral tonic pupils, vitreous haemorrhage and hypertensive chorioretinopathy which have not been reported in the literature to date.