Posterior reversible encephalopathy syndrome after postpartum cardiac arrest in hemolysis, elevated liver enzymes, and low platelet count syndrome: a case report

Posterior reversible encephalopathy syndrome (PRES) is a recognized neurological complication of hypertensive disorders of pregnancy, including HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, but diagnosis may be challenging when accompanied by cardiovascular instability.We report a rare case of fulminant PRES in a postpartum patient with severe HELLP syndrome complicated by seizure and subsequent cardiac arrest.Initial neurological evaluation was limited by post-resuscitation unresponsiveness and hemodynamic instability, raising concern for hypoxic-ischemic encephalopathy.Brain magnetic resonance imaging demonstrated widespread, non-territorial vasogenic edema without diffuse diffusion restriction, favoring PRES.With supportive intensive care and careful blood pressure management, the patient showed rapid neurological recovery, consistent with the reversible nature of PRES.This case highlights that PRES should be considered in postpartum patients with HELLP syndrome even after cardiac arrest and underscores the importance of early neuroimaging to distinguish PRES from hypoxic-ischemic injury, given their differing management and prognostic implications.