Posterior Reversible Encephalopathy Syndrome Associated With Eclampsia and Intrauterine Fetal Demise: A Case Report and Literature Review

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome that may occur in the setting of hypertensive disorders of pregnancy, particularly severe preeclampsia and eclampsia. It is characterized by acute neurological manifestations such as seizures, headache, visual disturbances, confusion, and characteristic neuroimaging abnormalities related mainly to vasogenic cerebral edema. We report the case of a 17-year-old primigravida with an unsupervised pregnancy estimated at 33 weeks of gestation, admitted to the obstetric emergency department for an eclamptic seizure. Obstetric ultrasound confirmed intrauterine fetal demise. Laboratory investigations showed significant proteinuria, thrombocytopenia, elevated liver enzymes, increased lactate dehydrogenase, and mild renal impairment, consistent with severe preeclampsia. Vaginal delivery resulted in the birth of a male fetus weighing 1655 g. Cerebral computed tomography performed after obstetric management revealed findings suggestive of PRES. The patient received multidisciplinary management with close monitoring, blood pressure control, and anticonvulsant therapy, followed by complete neurological recovery without residual deficits. This case highlights the importance of considering PRES in pregnant patients presenting with seizures or other neurological symptoms in the context of preeclampsia or eclampsia.