Abstract

Background: Posterior reversible encephalopathy syndrome or reversible posterior leukoencephalopathy syndrome presents with headache, seizures, altered consciousness and visual disturbances associated with conditions like acute hypertension, vascular and autoimmune disease, immunosuppressant drugs and organ transplantation. The incidence of involvement of the different regions of the brain is- parieto-occipital 98.7%; posterior frontal 78.9%; temporal 68.4%; thalamus 30.3%; cerebellum 34.2%; brainstem 18.4%; and basal ganglia 11.8 %.

Case Report: A 28 year old female (G3P2L2) presented in Emergency with  2-3 episodes of seizures. She was post caesarean section. Patient was in drowsy and disoriented state.BP-160/90mm Hg, pallor and oedema feet present. Neuroimaging was done which showed. CT (BRAIN):  hypodense area in bilateral occipital lobes, which was subcortical in origin (b) MRI BRAIN(PLAIN)T1 hypodensity and T2 flair hyper intensity signals involving cortical sulci, gyri of bilateral frontal lobes, occipital lobes, left temporal lobes and bilateral caudate nucleus and vasogenic oedema.MRI (venogram):normal. Patient was started on antiepileptics, antibiotics and osmotic diuretics. Improved over a period of 8 days and was discharged on antiepileptic.

Conclusion: Posterior reversible encephalopathy syndrome should be considered in patients   with seizures, altered consciousness, visual disturbances, headache particularly with chronic and acute kidney disease, organ transplantation, and use of immunosuppression. If recognised and treated promptly the rapid onset symptoms and radiological features resolve within days to weeks.

Keywords: 1.Posterior Reversible Encephalopathy Syndrome 2 Seizures. 3. Antiepileptics 4.Vasogenic Oedema