Reversible Cerebral Vasoconstriction Syndrome along with Posterior Reversible Encephalopathy Syndrome in a Postnatal Eclamptic Patient: A Case Report

Abstract

Reversible Cerebral Vasoconstriction Syndrome (RCVS) and Posterior Reversible Encephalopathy Syndrome (PRES) are rare neurological disorders. Although rare, the diagnosis of these conditions is now possible due to increased clinical awareness and the availability of newer generation diagnostic methods such as Magnetic Resonance Imaging (MRI). The rarity of their occurrence can sometimes lead to misleading diagnoses, as both illnesses rarely coexist and share certain clinical and radiological characteristics. RCVS progresses rapidly and can result in chronic impairment or even in-hospital mortality in 5-10% of cases. On the other hand, PRES is a monophasic and reversible illness, although there have been instances of recurrence. In this case report, the authors present the case of a 22-year-old female who presented with post-natal seizures and severe headaches, suspected to have RCVS along with PRES. Since RCVS and PRES share some overlapping pathophysiological conditions, the findings of MRI, including Fluid-Attenuated Inversion Recovery (FLAIR), CR-Magnetic Resonance Angiography (MRA), Apparent Diffusion Coefficient (ADC), and Diffusion-Weighted Imaging (DWI), along with their correlation with clinical features, can help in differentiation. Vasoconstriction has been reported as the main cause; hence vasodilators are primarily suggested for controlling seizures. The patient survived and showed improvement. Initially, the patient was monitored every 15 days for one month, followed by monthly follow-ups up to 8 months after discharge. The purpose of presenting this case is to enhance understanding of RCVS with PRES, including associated risk factors, which can lead to better outcomes through timely diagnosis. Improved outcomes can be achieved through early recognition and improved clinical management.

Keywords

• hypoxaemic respiratory failure
• magnesium sulfate
• neurological disorders