title: PP137. Posterior reversible encephalopathy syndrome (PRES) is a constant component of eclampsia.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) has been reported to occur in patients with eclampsia. In both conditions there is evidence to suggest disordered cerebral autoregulation.
  
  
  OBJECTIVE
  We sought to investigate the concurrence of PRES with eclampsia and to describe the associated obstetric, radiologic and critical care correlates.
  
  
  METHODS
  Single center 2001-2010 retrospective cohort study of all patients with eclampsia who underwent neuroimaging via magnetic resonance imaging (MRI) or computerized tomography (CT) with or without contrast. The medical records of all patients with eclampsia during the study interval were identified, evaluated and extracted for pertinent data; a diagnosis of PRES was made by radiologists using standard criteria.
  
  
  RESULTS
  Forty-six of forty-seven (97.9%) patients with eclampsia revealed PRES on neuroimaging using one or more modalities: MRI without contrast=41 (87.2%), MRI with contrast=27 (57.4%), CT without contrast=16 (34%), CT with contrast=7 (14.8%) and/or MRA/MRV=2 (4.3%). PRES was identified within the parietal (36, 78.3%), occipital (35, 76.1%), frontal (29, 63%), temporal (13, 28.3%) and basal ganglia/ brainstem/cerebellum (12, 26.1%). Eclampsia occurred antepartum in 23 patients, postpartum in 24 patients with 22 vaginal/25 cesarean deliveries at a mean maternal age of 21.8 years (range 15-39) and a mean gestational age of 33.9 weeks (range 22.4-41.7 weeks). Ethnicity was African-American in 38 patients. Headache was the most common presenting symptom (87.2%) followed by altered mental status (51.1%), visual disturbances (34%) and nausea/vomiting (19.1%). Severe systolic hypertension was present in 22 (47%) of patients.Use of antihypertensives (87%), magnesium sulfate (100%), diuretics (66%) and corticosteroids (50%) facilitated maternal recovery in all cases with usually a brief hospitalization (mean 3.9 days, range 1-20 days).
  
  
  CONCLUSIONS
  The common finding of PRES in patients with eclampsia suggests that PRES may be part of the pathogenesis of eclampsia. We speculate that therapy targeted at prevention or reversal of PRES pathogenesis will prevent or facilitate recovery from eclampsia.
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: J N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: J M
authors.initials: JM
authors.lastname: Brewer
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: P G
authors.initials: PG
authors.lastname: Blake
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: M Y
authors.initials: MY
authors.lastname: Owens
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: B
authors.initials: B
authors.lastname: LaMarca