‘PRES’SING problems in pregnancy: A case report

Posterior reversible encephalopathy syndrome (PRES) earlier called as reversible posterior leukoencephalopathy syndrome is a clinicoradiologic syndrome of heterogenous etiologies grouped together because of similar clinical and radiologic findings. Patients present with features of headache, confusion or decreased consciousness, visual complaints, and sometimes seizures of acute or subacute onset. The underlying etiology or inciting factors are variable, the most common being hypertension, renal disease, and immunosuppressive drugs. They are diagnosed based on the common radiologic finding of bilateral posterior cerebral white matter edema. Other radiologic findings may also be present. Such patients may present first to an ophthalmologist with complaints of sudden onset of defective vision or double vision. It is a reversible entity if identified early. Hence, high index of suspicion, quick diagnosis, and management are important. Here, we present the case of a 23-year-old primigravida with chronic hypertension who presented with sudden onset of defective vision followed by headache. Visual acuity was only perception of hand movements in both eyes. Ophthalmologic evaluation showed no abnormality to account for the visual loss. Brain imaging showed bilateral parieto-occipital white matter edema consistent with clinical diagnosis of PRES. After treatment of hypertension and supportive measures, the patient’s symptoms recovered, and her vision was 6/6 in both eyes on 1-week follow-up. Follow-up MRI also showed resolution of edema.