Preeclampsia With Posterior Reversible Encephalopathy Syndrome at 19 Weeks Gestation Resulting in Intrauterine Fetal Demise

TL;DR

A young pregnant woman developed severe preeclampsia and PRES at 19 weeks, leading to fetal death, highlighting the risks of untreated hypertension in pregnancy.

Contribution

This case report highlights the rare occurrence of PRES with preeclampsia before 20 weeks gestation and its severe consequences.

Findings

PRES can occur with preeclampsia before 20 weeks gestation.

The case resulted in intrauterine fetal demise despite PRES being typically reversible.

Prompt recognition and treatment of hypertensive disorders are crucial to prevent maternal and fetal complications.

Abstract

Posterior reversible encephalopathy syndrome (PRES) can be defined as a clinical syndrome of headache, seizures, visual disturbance, altered mental status, and characteristic magnetic resonance imaging (MRI) findings of vasogenic edema in the posterior subcortical parietal-occipital white matter. There are numerous potential inciting factors, including immunosuppression, renal disease, malignancy, cytotoxic medications, hypertension, preeclampsia, and eclampsia. In this paper, we present the case of a 21-year-old female at 19 weeks gestation presenting with symptoms consistent with preeclampsia with severe features and PRES. She was transferred to our facility after initial stabilization. She had an atypical course of preeclampsia prior to 20 weeks gestation, PRES lacking seizure activity, and ultimately her case resulted in intrauterine fetal demise (IUFD) at 20 weeks and six days gestation. As indicated by its name, PRES is considered a fully reversible syndrome, and the patient recovered after stabilization of her hypertensive disorder and delivery of the fetus. This case illustrates the importance of prompt recognition and treatment of hypertensive disorders in pregnant patients and the possibility of complications that can result in significant morbidity and mortality for both the mother and fetus.

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