
Clara R. McMillan
William Carey University College of Osteopathic Medicine
United States
Abstract Title: PRES Presenting with Syncope in the Setting of Eclampsia
Biography:
Clara R. McMillan is in her third year of medical school at WCUCOM. She is currently completing clinical rotations at Magnolia Regional Health Center in Corinth, MS. Having completed a year as an OMT Scholar, Clara McMillan is now interested in pursuing a residency in OB/GYN upon graduating from medical school, where she hopes to integrate OMT into her practice.
Research Interest:
Posterior reversible encephalopathy syndrome (PRES) is described as a clinical syndrome of headache, confusion or decreased level of consciousness, visual changes, and seizures, associated with characteristic neuroimaging findings of posterior cerebral white matter edema. A retrospective cohort study found that over 90% of eclamptic patients have neuroimaging findings consistent with PRES suggesting that PRES is relevant to the pathogenesis of eclampsia. Treatment for PRES is supportive and focused on treating the underlying medical condition. We present a case of a 21-year-old female who presents to the emergency department (ED) with a complaint of syncope, headaches, and dizziness. She had not been seen by a physician since a dilation and curettage was performed for a missed abortion 8 months prior and was lost to follow up. On evaluation in the ED, she appeared to be anxious and had a palpable abdominal mass on the physical exam. Vitals were concerning for tachycardia and hypertension with a diastolic of 110. Shortly after arrival at the ED, the patient began seizing. Differential diagnoses considered were molar pregnancy, eclampsia, Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome, and PRES. Workup was significant for positive pregnancy test with a b-hCG of 36,566; Urine analysis showed 600 mg protein and a moderate amount of blood; Head CT showed nonspecific subtle bilateral occipital hypodensities. A late abdominal ultrasound was obtained which identified a roughly 25-week fetus with multiple anatomic abnormalities and severe oligohydramnios. The final diagnosis was Eclampsia with concomitant PRES considering her concerning head CT results. Management in the ED focused on seizure control and the patient was transferred to a tertiary center for a higher level of care given multitude of anatomic abnormalities and severe oligohydramnios. Thank you to Drs. Huffman and Graham for your assistance with this patient. Keywords: PRES, eclampsia, syncope