Postpartum Normotansif PRES Olgusu

Abstract

A 33-year-old woman within one week postpartum (C/S) was admitted to the emergency department with headache, nausea and vomiting, visual loss, high fever, loss of consciousness and full body muscle contractions. Peripartum period had been uneventful with no history of hypertension before or during pregnancy. Left hemihipoestesia and reduced visual acuity in left side (20/100) involved in neurological examination. Lumber puncture (LP) was performed for meningitis. There was no significant finding in cerebrospinal fluid examination (CSF). During follow-up one episode of generalized tonic clonic seizure which lasted three minutes occurred. Bilateral occipitale hiperintens lesions were determined at FLAIR sequence in MRI of brain following seizure. Valproic acid (1000 mg/day) was started. After 24 hours, control MRI showed tubuler hyperintensity located in bilateral occipital lob. She had normal MR venography and vasculitis markers. The MRI findings were suggesting PRES. The final diagnose was comfirmed as PRES. After one month, neurological examination and MRI was normal. Valporic acid was reduced and stopped.

Keywords

• Posterior Reversible Encephalopathy Syndrome
• Postpartum
• Headache
• Seizure

Postpartum Normotansif PRES Olgusu

Abstract

33 yaşındaki kadın hasta; postpartum birinci haftada baş ağrısı, ateş yüksekliği (39°), bulantı-kusma, görme bulanıklığı, vücutta yaygın kasılma ve bilinç kaybı yakınmalar ile acil servise başvurdu. Hastanın gebelik sırasındaki takiplerinde kan basınç yüksekliği olmamıştı. Hastanın nörolojik muayenesinde solda görme keskinliğinde azalma (20/100) ve sol hemihipoestezisi mevcuttu. Hastaya menenjit ön tanısı ile lomber ponksiyon (LP) yapıldı. Beyin omurilik sıvısı(BOS) açılışı basıncı 13 cm/su bulundu. BOS bulgular normaldi. Ardından yaklaşık üç dakika süren jeneralize tonik klonik nöbeti oldu. Nöbet sonrası yeniden çekilen kranyal MRG’de FLAIR sekansında bilateral oksipitalde hiperdens alan saptandı. Hastaya valproik asit 1000 mg bağlandı. 24 saat sonra çekilen kontrol kranyal MRG’de FLAIR sekansnda bilateral oksipital bölgede tübüler hiperdens yap gözlemlendi. Kranyal manyetik rezonans venografisi (MRV) ve vaskülit belirteçleri normaldi. Bu kranyal MRG bulgular PRES ile uyumlu bulundu. Hastanın 1 ay sonraki kontrolünde nörolojik muayene bulgular ve kranyal MRG’si normale dönmüştü. Ardından hastanın valproik asidi azaltılarak kesildi.

Keywords

• Posterior Reversible Ensefalopati Sendromu
• Postpartum
• BaĹ Aþrs
• Nöbet

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