Open AccessPosterior reversible encephalopathy syndrome, preeclampsia or stroke? A diagnostic dilemma
Author(s) -
Vikesh Patel,
Bhavna Ramachandran,
Ifrah Omar
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-230281
Subject(s) - medicine , posterior reversible encephalopathy syndrome , preeclampsia , stroke (engine) , headaches , nausea , pregnancy , encephalopathy , eclampsia , pediatrics , neurology , surgery , magnetic resonance imaging , radiology , mechanical engineering , psychiatry , biology , engineering , genetics
When a pregnant woman presents with headaches, visual disturbances, epigastric pain and nausea, preeclampsia quickly springs to mind. This case describes a primigravid 22-year-old female of 32 weeks gestation who presented with the symptoms described but was found to be apparently normotensive. Due to ongoing symptoms and diagnostic uncertainty in the absence of definitive evidence of preeclampsia, the patient was further investigated with an MRI brain scan, which was reported as either an acute stroke or an atypical presentation of posterior reversible encephalopathy syndrome. Together with blood results that showed heterozygosity for Factor V Leiden, we concluded that while the patient's clinical diagnosis was certainly preeclampsia, her investigations also supported an unexpected diagnosis of silent brain infarction. This report outlines a diagnostic dilemma that required multidisciplinary working between obstetricians, neurologists, radiologists and stroke physicians to manage the patient who went on to make a full recovery and deliver a healthy baby.