Background Acute neurological emergencies in pregnant and postpartum women presenting as headache, visual disturbances, seizures, and elevated blood pressure are usually attributed to preeclampsia and eclampsia. However cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two important, rare conditions which should be considered. PRES is a rare neuroradiological syndrome characterised by vasogenic oedema of subcortical white matter, commonly involving posterior cerebral hemispheres. Preeclampsia and eclampsia are the common causes of PRES. However, late postpartum eclampsia concurrent to PRES is rare. Here, we report a rare case of PRES secondary to late postpartum eclampsia with atypical radiological findings. Case presentation A 25-year-old married woman with prior history of two spontaneous abortions presented to us on day 5 postpartum, post lower segment caesarean section (LSCS) with complaints of headache followed by one episode of new onset generalised tonic-clonic seizures. There was no history of seizures prior to the pregnancy and no history of hypertension or diabetes during any of her pregnancies. On examination, BP was 140/90 mm Hg and PR 98 bpm. Systemic examination revealed GCS 15/15, no focal neurological deficits, and bilateral flexor plantar response. Fundus examination was normal with no evidence of hypertensive retinopathy. Preliminary haematological and biochemical tests including antiphospholipid antibody (APLA) profile were done in view of prior abortions and were within normal limits. Lumbar puncture was done—normal study. EEG was normal. MRI with MRV was suggestive of atypical posterior encephalopathy. In view of late onset postpartum seizure, the patient was started on injection of magnesium sulphate, anti-hypertensives, and antiepileptics; following which, she improved and was discharged. Conclusion Though preeclampsia and eclampsia are usually screened entities, we should also follow women in puerperium for late postpartum eclampsia which is defined as seizures beyond 48 h of delivery up to 4 weeks postpartum. So it is important to follow-up postpartum women for complications like PRES because early detection and treatment can lessen the morbidity and mortality as they are completely reversible. Thus, health care professionals should be educated about the same. Apart from antenatal and intrapartum care, postpartum care should also be given equal importance.

中文翻译：

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后部可逆性脑病综合征的不寻常表现——病例报告

背景 孕妇和产后妇女的急性神经系统急症表现为头痛、视力障碍、癫痫发作和血压升高，通常归因于先兆子痫和子痫。然而，脑静脉窦血栓形成 (CVST) 和后部可逆性脑病综合征 (PRES) 是两种重要的、罕见的情况，应予以考虑。PRES 是一种罕见的神经放射学综合征，其特征是皮层下白质血管源性水肿，通常累及大脑后半球。先兆子痫和子痫是 PRES 的常见原因。然而，晚期产后子痫并发 PRES 是罕见的。在这里，我们报告了一个罕见的 PRES 病例，继发于晚期产后子痫，具有非典型的放射学发现。病例介绍 一名 25 岁已婚妇女，既往有两次自然流产史，在产后第 5 天，下段剖腹产 (LSCS) 后主诉头痛，随后出现一次新发全身性强直阵挛性癫痫发作。怀孕前没有癫痫病史，在她怀孕期间也没有高血压或糖尿病病史。检查时，BP 为 140/90 mm Hg，PR 为 98 bpm。全身检查显示 GCS 15/15，无局灶性神经功能缺损，双侧屈肌足底反应。眼底检查正常，没有高血压视网膜病变的证据。鉴于先前的流产情况，进行了包括抗磷脂抗体 (APLA) 谱在内的初步血液学和生化检查，结果均在正常范围内。进行了腰椎穿刺——正常研究。脑电图正常。MRV MRI 提示非典型后脑病。鉴于产后癫痫发作较晚，患者开始注射硫酸镁、抗高血压药和抗癫痫药；随后，她好转出院。结论虽然先兆子痫和子痫通常是筛查实体，但我们也应该跟踪产褥期妇女的晚期产后子痫，即分娩后 48 小时至产后 4 周的癫痫发作。因此，对产后妇女进行 PRES 等并发症的随访非常重要，因为早期发现和治疗可以降低发病率和死亡率，因为它们是完全可逆的。因此，医疗保健专业人员应该接受同样的教育。除了产前和产时护理，产后护理也应同等重视。