Transient cortical blindness at delivery-an unusual case report on posterior reversible encephalopathy syndrome

Background: Posterior reversible encephalopathy syndrome (PRES) is an unusual clinical entity seen associated with blood pressure (BP) fluctuations presenting with acute neurological symptoms. This is an unusual case of PRES due to severe preeclampsia, with clinical presentation of cortical blindness and hypertension, with absence of headache or seizures. Case Presentation: A primigravida, with no significant medical history, presented with significant proteinuria and worsening generalized itching and normotensive at 37 weeks 6 days of gestation. Due to elevated urate and raised urine protein induction of labor was planned. Ten minutes after vaginal delivery, patient reported sudden loss of vision with only being able to perceive light. She developed hypertension, hyperreflexia, and clonus. Aggressive management for severe pre-eclampsia was initiated. Her vision started improving as soon as her BP started normalizing. Imaging revealed the possibility of PRES with a superimposed focus of acute ischemia. She was discharged on antihypertensives and followed up by renal physicians. Within 2 months she recovered very well. Conclusion: This is an unusual case of PRES due to severe pre-eclampsia, with clinical presentation of only cortical blindness with absence of headache or seizures. Prompt recognition and aggressive management of severe pre-eclampsia resulted in resolution of symptoms.