Deshmukh Varsha, Gangurde Vikas R, Gadappa Shrineewas
Department of OBGY, GMC and Cancer Hospital, Aurangabad, Maharashtra India.
Department of OBGY, GMC, Aurangabad, Maharashtra India.
J Obstet Gynaecol India. 2022 Aug;72(Suppl 1):192-197. doi: 10.1007/s13224-021-01585-9. Epub 2022 Mar 5.
Posterior reversible encephalopathy syndrome (PRES) and the related term reversible posterior leukoencephalopathy syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. Eclampsia associated with PRES is a rare condition and remains a challenging diagnosis to make. There are only a few studies regarding PRES syndrome with a limited sample size. Our institution is a tertiary referral centre; hence, a good sample size of patients with eclampsia complicated with PRES syndrome is seen in our study. The objective was to identify the maternal and neonatal outcomes in PRES with eclampsia.
This study is a prospective observational study done in Government Medical College, Aurangabad, India from October 2018 to September 2020. In the present study, we have enrolled 63 cases, who satisfied inclusion and exclusion criteria during two years. All women admitted in the labour room of tertiary health care centre diagnosed with eclampsia with neurological symptoms during the study period were studied. Relevant data were obtained from the case file and compiled by common proforma. Analysis was done by SPSS (Statistical package for social sciences) Version 25th.
In patients with a confirmed diagnosis of PRES with eclampsia(n = 63), the mean age of the patient was 20.74 ± 2.04 years, 23 (36.5%) patients had headache as premonitory symptoms, whereas 13(20.6%)patients had visual disturbances as the premonitory symptom. The mean gestational age at presentation was 34.4 ± 2 weeks. 40(63.5%) patients were showing parieto-occipital region changes, and 24(38.1%) subjects were showing only occipital region involvement in CT brain. 12 (19.04%) subjects were diagnosed with HELLP syndrome as a maternal complication, 07 (11.1%) subjects had Abruptio placentae. 26(41.3%) babies needed NICU admission, and 4 (6.3%) babies had neonatal death.
In pregnant patients presenting with seizure and neurological symptoms, a possibility of PRES should be considered. Proper diagnosis requires careful attention to clinical and radiographic presentation. In eclampsia with PRES patients, a timely intervention with anti-hypertensive, anti-cerebral oedema measures as well as management of other associated symptoms are required.
The online version contains supplementary material available at 10.1007/s13224-021-01585-9.
后部可逆性脑病综合征（PRES）及相关术语可逆性后部白质脑病综合征（RPLS）指的是一系列临床症状与关键影像学表现相结合的情况。子痫合并PRES是一种罕见病症，诊断仍具有挑战性。关于PRES综合征的研究较少，样本量有限。我们机构是一家三级转诊中心；因此，在我们的研究中可以看到子痫合并PRES综合征患者的样本量较大。目的是确定子痫合并PRES时的孕产妇和新生儿结局。
本研究是一项前瞻性观察性研究，于2018年10月至2020年9月在印度奥兰加巴德政府医学院进行。在本研究中，我们纳入了63例在两年内符合纳入和排除标准的病例。对在研究期间三级医疗保健中心产房收治的所有诊断为子痫且伴有神经症状的女性进行研究。从病例档案中获取相关数据，并通过通用表格进行整理。采用社会科学统计软件包（SPSS）第25版进行分析。
在确诊为子痫合并PRES的患者（n = 63）中，患者的平均年龄为20.74±2.04岁，23例（36.5%）患者以头痛作为先兆症状，而13例（20.6%）患者以视觉障碍作为先兆症状。就诊时的平均孕周为34.4±2周。40例（63.5%）患者在CT脑部检查中显示顶枕叶区域改变，24例（38.1%）受试者仅显示枕叶区域受累。12例（19.04%）受试者被诊断为发生HELLP综合征作为孕产妇并发症，7例（11.1%）受试者发生胎盘早剥。26例（41.3%）婴儿需要入住新生儿重症监护病房，4例（6.3%）婴儿发生新生儿死亡。
对于出现癫痫发作和神经症状的孕妇，应考虑PRES的可能性。正确诊断需要仔细关注临床和影像学表现。对于子痫合并PRES的患者，需要及时采取抗高血压、抗脑水肿措施以及处理其他相关症状。
在线版本包含可在10.1007/s13224-021-01585-9获取的补充材料。
