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Clinical and Experimental Obstetrics & Gynecology  2021, Vol. 48 Issue (4): 982-986    DOI: 10.31083/j.ceog4804156
Case Report Previous articles | Next articles
Posterior reversible encephalopathy syndrome with reversible cerebral vasoconstriction syndrome in a normal primigravida woman at the 35-week gestational stage: a case report
Shingo Tanaka1, *(), Maki Goto1, Saya Watanabe1, Sachino Kira1, Sotaro Hayashi1, Shigeki Fujimoto1, Miho Oda1, Lifa Lee1, Yoko To1, Satoshi Nishiyama1, Fuyuki Eguchi1, Hiroshi Tsujioka1
1Iizuka Hospital Obstetrics and Gynecology, Yoshiomachi, 3-83 iizukashi, Fukuokakenn, Japan
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Abstract  
Background: Herein, we report a case of cerebral hemorrhage in a 21-year-old nulliparous, primi gravida woman caused by posterior reversible encephalopathy syndrome (PRES), which may be associated with reversible cerebral vasoconstriction syndrome (RCVS). Case: The patient's medical history was unremarkable, apart from the mother having had a cerebral infarction. She had been examined by a local doctor, and showed good progress; however, her blood pressure (BP) was 143/97 mmHg, she had findings of proteinuria (3+) and she had a headache on the 35th week with multiple vomiting episodes. She was admitted to our hospital after poor responsiveness and a consciousness level of GCS14, E4V4M6, a BP of 143/97 mmHg, a pulse rate of 77/min, bilateral abduction of the eyes, and left hemiplegia. Cranial computed tomography (CT) revealed cerebral hemorrhage with ventricular puncture in the right caudate nucleus. Emergency caesarean section was performed on the same day with priority given to maternal lifesaving. Acute cerebral infarction findings and PRES were observed on head magnetic resonance imaging (MRI) on the admission day 1. Head MR angiography on the 4th hospital day showed narrowing of the entire main artery trunk, suspected as RCVS. Short-term memory deficits were diagnosed post-extubation, but gradually improved. Although it became possible and hematoma in the ventricles were absorbed, left paresis and higher dysfunction were observed, and she was discharged on the 21st hospital day. Conclusion: PRES and RCVS occur simultaneously quite frequently, but require opposing treatment approaches. Both cases are reversible, but if they occur simultaneously, RCVS, which progresses slowly, may cause irreversible symptoms, thereby requiring careful treatment.
Key words:  Preeclampsia      Hypertensive crisis      Left hemiplegia      Posterior reversible encephalopathy syndrome      Reversible cerebral vasoconstriction syndrome     
Submitted:  05 November 2020      Revised:  03 January 2021      Accepted:  07 January 2021      Published:  15 August 2021     
*Corresponding Author(s):  Shingo Tanaka     E-mail:  t.shingo.100096@gmail.com

Cite this article: 

Shingo Tanaka, Maki Goto, Saya Watanabe, Sachino Kira, Sotaro Hayashi, Shigeki Fujimoto, Miho Oda, Lifa Lee, Yoko To, Satoshi Nishiyama, Fuyuki Eguchi, Hiroshi Tsujioka. Posterior reversible encephalopathy syndrome with reversible cerebral vasoconstriction syndrome in a normal primigravida woman at the 35-week gestational stage: a case report. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(4): 982-986.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog4804156     OR     https://ceog.imrpress.com/EN/Y2021/V48/I4/982

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