Posterior reversible encephalopathy syndrome following eclampsia in a primigravida at 35 weeks of gestation: A case report

Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological disorder most commonly triggered by eclampsia and characterized on imaging by vasogenic edema, typically involving the parieto-occipital regions. We describe a 26-year-old primigravida at 35 weeks of gestation who presented with headache, dyspnea, and a generalized tonic-clonic seizure, with severe hypertension (200/110 mmHg), 3+ proteinuria, serum creatinine (1.1 mg/dL), and platelet count (100,000/mm 3 ) consistent with severe preeclampsia with superimposed eclampsia. She underwent emergency lower-segment cesarean section (LSCS) for delivery of a live neonate, with a second intraoperative seizure controlled with intravenous diazepam and magnesium sulfate. Postoperatively, she developed sudden bilateral visual loss without focal neurological deficit. Brain MRI showed bilateral, symmetric T2- and FLAIR-hyperintense signal in the parieto-occipital white matter without evidence of restricted diffusion on DWI/ADC a pattern of vasogenic edema diagnostic of PRES. She was treated with intravenous magnesium sulfate, antihypertensive therapy, and levetiracetam, with complete clinical recovery and radiological resolution on follow-up imaging. This case highlights eclamptic PRES as a cause of postoperative cortical visual loss and illustrates how the combination of T2/FLAIR signal change with preserved diffusion on MRI distinguishes reversible vasogenic edema from ischemic injury, supporting prompt, targeted management even in resource-limited settings.