Posterior reversible encephalopathy syndrome in pregnancy: a retrospective series of 36 patients from mainland China.
BACKGROUND
Posterior reversible encephalopathy syndrome (PRES) is associated with variable predisposing risk factors including preeclampsia and eclampsia since it proposed. However, studies of large case series focusing on pregnancy-related PRES are still limited. We performed a large retrospective study of patients with pregnancy-related PRES admitted to our institution.


METHODS
This was a single-center, 2010-2015 retrospective cohort study of patients with pregnancy-related PRES who underwent neuroimaging via magnetic resonance imaging or computerized tomography from mainland China.


RESULTS
26 of 28 women with eclampsia and 7 of 59 women with preeclampsia had confirmed PRES. A total of 36 patients were finally included as confirmed pregnancy-related PRES in this research. Acute hypertension was present in 31 patients (86%). Headache was the most common presenting symptom (81%) followed by seizures (73%), altered mental status (57%), nausea/vomiting (47%) and visual disturbance (33%). Atypical involved regions included frontal lobe (72%), temporal lobe (67%), basal ganglia (50%), cerebellum (47%), brain stem (14%) and thalamus (8%). Atypical neuroimaging features included restricted diffusion (33%), contrast enhancement (19%) and hemorrhage (19%). Comorbidities included thrombocytopenia (25%), pulmonary infection (25%), anemia (19%), fever (17%), acute renal failure (8%), HELLP syndrome (6%), DIC (6%). Most of patients recovered completely with timely diagnosis and treatment. Two patients who suffered DIC finally died.


CONCLUSIONS
Patients with pregnancy-related PRES may present with atypical neuroimaging findings. Moreover, our data supported the view that nearly all imaged patients with eclampsia had clinical and radiologic findings of PRES.
Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Y
Wen
Department of Neurology, Xiangya Bo'ai Rehabilitation Hospital, 61 Wanjiali Road, Changsha, 410151, Hunan, People's Republic of China.
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B
Yang
Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Huang
Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China. yunhail@163.com.
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Liu
D000293:Adolescent; D000328:Adult; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
Eclampsia; Intracranial hemorrhage; Posterior reversible encephalopathy syndrome; Preeclampsia; Pregnancy