title: Therapy and differential diagnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum.
abstract: OBJECTIVE
  Posterior reversible encephalopathy syndrome (PRES) is an usually reversible neuro-radiological clinical entity characterized by headache, confusion, visual disturbances or blindness and seizures. It rarely occurs without seizures.
  
  
  METHODS
  We conducted a literature review in MEDLINE about PRES during post partum and pregnancy, focusing on differential diagnosis and therapy. We reviewed 28 articles (case reports, original articles and reviews) describing PRES as well as a case of a severe, immediate postpartum HELLP syndrome (haemolysis, elevated liver enzyme levels, low platelet count) with PRES without generalized seizure.
  
  
  RESULTS
  The development of PRES after delivery is unusual. Magnetic resonance imaging represents the gold standard for the diagnosis of this condition. White matter oedema in the posterior cerebral hemispheres is typical on neuroimaging. PRES is reversible when early diagnosis is established and appropriate treatment is started without delay. The pathogenesis of PRES is discussed and the importance of a prompt diagnosis is emphasized, as the crucial role of rapid blood press reduction.
  
  
  CONCLUSIONS
  MRI is the diagnostic gold standard and it may be useful in the differential diagnosis. The goal of the therapy is to control elevated blood pressure and to prevent seizures or promptly manage it.
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Largo Brambilla, 350134, Florence, Italy. maurocoz@yahoo.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cozzolino
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Largo Brambilla, 350134, Florence, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bianchi
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Largo Brambilla, 350134, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Mariani
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Largo Brambilla, 350134, Florence, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Marchi
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Largo Brambilla, 350134, Florence, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Largo Brambilla, 350134, Florence, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mecacci
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis* / Q000628:therapy*; D049590:Postpartum Period; D011247:Pregnancy; D012640:Seizures / Q000209:etiology
keywords: Eclampsia; HELLP syndrome; Hypertension; Imaging; Pregnancy