Posterior reversible encephalopathy syndrome following severe postpartum hemorrhage: An atypical diffuse MRI pattern of brain involvement

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological complication that may occur in the setting of severe postpartum hemorrhage (PPH). We report the case of a 28-year-old grand multiparous woman with a term twin pregnancy who developed severe PPH during an emergency cesarean section, complicated by hemodynamic instability and metabolic acidosis. Postoperatively, she developed seizures, aphasia, and generalized weakness. Brain magnetic resonance imaging demonstrated bilateral diffuse cortical and subcortical hyperintense signal abnormalities involving the frontoparietal and occipital lobes on FLAIR and T2-weighted sequences, with mild associated diffusion restriction, findings consistent with an atypical diffuse pattern of PRES and associated hypoxic-ischemic brain injury. The patient required prolonged intensive care, including ventilatory support, blood transfusions, antiepileptic therapy, and management of cerebral edema. Gradual neurological improvement was observed following multidisciplinary care and rehabilitation. This case highlights the importance of early recognition, prompt neuroimaging, and timely multidisciplinary management of neurological complications following severe PPH to improve outcomes.