Background and Aims Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by headaches, seizures, altered consciousness and visual disturbances. The authors describe a clinical case of PRES to highlight the importance of clinical differences between this syndrome and post-dural puncture headache (PDPH).
Methods 45-year-old female, ASA II, with 2 previous cesarian sections (CS) was admitted for an elective CS. Anesthesia was performed uneventfully with combined spinal-epidural anesthesia. No history of gestational hypertension, neurological pathology, vascular malformations or cranioencephalic trauma. A headache with PDPH characteristics developed 24h post CS and responded favorably to conservative analgesic therapy. At 72h post CS, the characteristics of the headache changed, becoming continuous with associated tinnitus and photophobia. Simultaneously she presented high blood pressure, nausea and vomiting. An epidural blood-patch was performed, with no evidence of complications and immediate symptomatic relief was achieved.
Results Three hours after the epidural blood-patch, the patient had a seizure. The brain CT was compatible with reversible cerebral vasoconstriction syndrome. She was admitted in the Intensive Care Unit for monitorization and treatment of blood pressure as well as symptomatic surveillance. She then performed a brain MRI which confirmed PRES. The patient demanded hospital discharge against medical advice and suspended therapy at this point. She is asymptomatic since then, maintaining a normal baseline arterial pressure.
Conclusions PRES is an entity that can simulate an obstetric emergency, being an extremely important differential diagnosis of PDPH. This requires additional brain imaging exams and a multidisciplinary discussion.
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