Yeh Wei-Chih, Liou Li-Min, Wu Meng-Ni
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Medicine (Baltimore). 2020 Jan;99(4):e18877. doi: 10.1097/MD.0000000000018877.
Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD).
A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria.
PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia.
The patient received levetiracetam and valproate for seizure management.
Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission.
PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.
后部可逆性脑病综合征（PRES）是一种罕见的神经系统疾病，表现为头痛、精神状态改变、癫痫发作、视觉障碍以及其他局灶性神经体征，临床症状和影像学改变通常是可逆的。尽管其潜在机制尚不清楚，但目前有一种理论认为脑自动调节功能衰竭是主要原因。我们报告一例宫内胎儿死亡（IUFD）的成人患者发生PRES并伴有卒中的病例。
一名35岁的亚洲双胎妊娠女性因IUFD在妊娠32周时接受了剖宫产。剖宫产术后2天，她出现了局灶性癫痫发作和视野缺损。她的血压以及肾脏、肝脏和凝血功能正常，无蛋白尿。
根据一系列脑磁共振成像结果诊断为PRES。右额叶的缺血性梗死最终发展为脑软化。
患者接受左乙拉西坦和丙戊酸盐治疗以控制癫痫发作。
发病5天后，癫痫发作得到控制。入院21天后，所有神经功能缺损完全改善。
PRES可发生于无先兆子痫或子痫症状的IUFD女性患者。尽管大多数病例会导致脑血管源性水肿且预后良好，但PRES也可引起细胞毒性水肿并对大脑造成永久性损害。
