Unilateral visual loss; A case of posterior reversible encephalopathy at early gestation
Arulnesan AC, Isanka S, Ithayarooban E, Senthinathan PG

A 24-year-old primigravida with the period of amenorrhoea of 24 weeks and 3 days
presented with sudden onset of bilateral blurring of vision that progressed to left loss of
vision. On admission she developed two episodes of focal seizure of left upper limb, each
episode lasted around 2 minutes. There was post ictal drowsiness and generalized headache
but no urinary or faecal incontinence or aura. She did not have any medical illness and not
on any long-term medication.
On preliminary examination her GCS (Glasgow coma scale) was 14, tachycardic with the rate
of 110 beats and blood pressure was 200/100 mmHg. There were no focal weakness or
sensory impairment or papilledema. Urine protein was negative.
The diagnosis was made as eclampsia and immediately given intravenous (IV) Labetalol,
hydralazine and magnesium sulphate to stabilize the blood pressure. After multidisciplinary
discussion she had undergone emergency hysterotomy under spinal anaesthesia. Birth
weight of the neonate was 470 g and succumbed.
Apart from thrombocytopenia blood investigations were unremarkable. Antinuclear
antibody (ANA) was negative.
Magnetic resonance image (MRI) of brain with arterial and venous phase confirmed PRES.
The patient showed remarkable recovery with antihypertensive medication and supportive
therapy.