BRAVING THE STORM: SURVIVING PREECLAMPSIA, HELLP SYNDROME AND PRES: A CASE REPORT
Authors: Uday Rajini , Shah Diya , Nayak U Ashwini , Sanjota Honnareddy , Yuktha K B , Munavar K Syed Ali 
Published: November 2024

Aim And Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a medical enigma that lies at the intersection of neurology and
obstetrics. First described by Hinchey et al. in 1996, PRES is marked by a dramatic constellation of symptoms: severe headache, seizures, visual
disturbances, and altered mental status. The pathophysiology of PRES is as complex as its presentation, often involving a breach in the blood-brain
barrier precipitated by acute hypertension or endothelial dysfunction leading to characteristic edema, predominantly affecting the parieto-occipital
regions of the brain. In this context, we delve into the case of a 19-year-old primigravida, whose journey through the triple challenges of PreEclampsia, HELLP syndrome, and PRES exemplies the essence of resilient motherhood. By exploring her case, we aim to shed light on the
critical importance of early recognition and comprehensive management of PRES in pregnancy, ensuring better outcomes. Case Description: A 19
year old primigravida at 26 weeks of gestation presented with preeclampsia with severe features, with impending eclampsia with HELLP
syndrome. She experienced bilateral lower limb weakness postpartum. Based on clinical examination and radiological imaging, she was diagnosed
with PRES. Management included blood pressure control using intravenous and oral antihypertensives, anticonvulsant and neuroprotective
agents. Supportive care was provided, including close monitoring of neurological status. The multidisciplinary approach involved obstetricians,
neurologists, and intensive care specialists, ensuring comprehensive care. Recovery was uneventful with scheduled followup. This Conclusion:
case underscores the critical importance of early detection of PRES in pregnant women with preeclampsia. Prompt diagnosis through clinical
assessment and radiological imaging is vital for initiating appropriate treatment and averting serious complications. Although the development of
PRES involves various mechanisms, effective management primarily focuses on controlling hypertension and addressing the root cause. With
timely intervention, the prognosis is generally positive, but additional research is needed to thoroughly understand the pathophysiological
processes and rene treatment protocols. Understanding PRES is vital because it can be reversible i Clinical Significance: f treated promptly. With
diverse range of symptoms, often associated with elevated blood pressure- pregnant women with preeclampsia are at risk. Early detection through
clinical assessment and radiological imaging followed by proper management can prevent severe complications, signicantly improving patient
prognosis. Recognising PRES helps distinguish it from other neurological disorders, ensuring precise diagnosis and appropriate treatment, thus
enhancing patient care quality. This case highlights the critical management of severe preeclampsia and the necessity of a coordinated
multidisciplinary approach. The timely intervention was essential in managing maternal and fetal outcomes. The transient lower limb weakness
post-delivery was notable, underscoring the importance of thorough neurological assessment in such cases. Severe preeclampsia with HELLP
syndrome and IUGR presents signicant management challenges requiring prompt and comprehensive care. This case emphasizes the importance
of vigilant monitoring and multidisciplinary strategies to prevent adverse outcomes.