Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in Late Onset Postpartum Eclampsia- A Retrospective Study

PRES in late postpartum eclampsia

  • Vikrant Kanagaraju Associate Professor, Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
  • B Devanand PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India


Background: Reversible posterior leukoencephalopathy syndrome (RPLS) or Posterior reversible encephalopathy syndrome (PRES) is a unique clinicoradiologic entity characterized by acute onset headache, seizures, blindness and altered mental state associated with reversible vasogenic edema of the brain. It is a major complication of eclampsia, but data on clinicoradiological features of PRES in late-onset postpartum eclampsia are scarce. The objective is to analyze the clinicoradiologic features and outcome in a cohort of late postpartum eclampsia patients with PRES. Subjects and Methods: Eighteen patients of late postpartum eclampsia with clinical as well as neuroimaging features consistent with PRES were included in this retrospective study. All had undergone magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) and apparent diffusion coefficient(ADC) mapping. Data on age, antepartum history, peak systolic and diastolic blood pressures, clinical features, time to neuroimaging, location of lesions on brain imaging and presence of associated ischemia or hemorrhage in MRI were collected and analyzed. Results: The mean age was 25.72 3.23 years. The average duration between labor and clinical symptoms was 8.5 days. 13/18 patients (72.2%) had elevated blood pressure at admission. Mean systolic and diastolic blood pressures were 143.88 (120-180) and 93.88 (80-100) mm Hg respectively. Headache was the presenting feature in 16 patients. The parieto-occipital regions were the most frequently involved followed by the cerebellum (7/18) and frontal lobe (4/18). Atypical regions were not involved. Clinical recovery had been noted in all. Conclusion: PRES associated with late postpartum eclampsia, an entity of limited awareness can present without antecedent preeclampsia. Radiological changes are the key to early diagnosis.


Download data is not yet available.


Lubarsky SL, Barton JR, Friedman SA, Nasreddine S, Ramadan MK, Sibai BM. Late Postpartum Eclampsia Revisited. Obstet Gynecol. 1994;83(4):502–505. Available from:

Piccioni MG, Schiavi MC, Colagiovanni V, Zannini I, Musella A, Visentin VS, et al. Posterior Reversible Encephalopa- thy Syndrome in late postpartum eclampsia. Clin Ter. 2015;166(2):68–71. Available from:

Zhang L, Wang Y, Shi L, Cao J, Li Z, Wáng YX. Late postpartum eclampsia complicated with posterior reversible encephalopathy syndrome: a case report and a literature review. Quant Imaging Med Surg. 2015;5(6):909–916. Available from:

Bo QY, Zhao XH, Yang X, Wang SJ. Reversible pos- terior encephalopathy syndrome associated with late onset postpartum eclampsia: A case report. Exp Ther Med. 2016;12(3):1885–1888. Available from:

Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A Reversible Posterior Leukoencephalopathy Syndrome. N Engl J Med. 1996;334(8):494–500. Available from:

Bartynski WS. Posterior Reversible Encephalopathy Syn- drome, Part 1: Fundamental Imaging and Clinical Features. Am J Neuroradiol. 2008;29(6):1036–1042. Available from:

Brewer J, Owens MY, Wallace K, Reeves AA, Morris R, Khan M, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208(6):1–6. Available from: j.ajog.2013.02.015.

Veltkamp R. Late onset postpartum eclampsia without pre- eclamptic prodromi: clinical and neuroradiological presentation in two patients. J Neurol Neurosur PS. 2000;69(6):824–827. Available from:

Raps EC, Galetta SL, Broderick M, Atlas S. Delayed peripartum vasculopathy: Cerebral eclampsia revisited. Ann Neurol. 1993;33(2):222–225. Available from:

Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT, Garada B, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. Am J Roentgenol. 1992;159(2):379–383. Available from:

Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in Posterior Reversible Encephalopathy Syn- drome: Imaging and Clinical Features. Am J Neuroradiol. 2009;30(7):1371–1379. Available from:

Provenzale JM, Petrella JR, Cruz LC, Wong JC, Engelter, Bar- boriak DP. Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome. Am J Neuro- radiol. 2000;22:1455–1461.

Schwartz RB, Feske SK, Polak JF. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology. 2000;217(2):371–376. Available from:

Liman TG, Bohner G, Heuschmann PU, Endres M, Siebert E. The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol. 2012;259(1):155–164. Available from:

Lamy C, Oppenheim C, Mas JL. Posterior reversible encephalopathy syndrome. Handb Clin Neurol. 2014;121:1687–1701.

Dziewas R, Stögbauer F, Freund M, Lüdemann P, Imai T, Holzapfel C, et al. Late onset postpartum eclampsia: a rare and difficult diagnosis. J Neurol. 2002;249(9):1287–1291. Available from: z.

McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior Reversible Encephalopathy Syndrome: Incidence of Atypical Regions of Involvement and Imaging Findings. Am J Roentgenol. 2007;189(4):904–912. Available from:

Liman TG, Bohner G, Heuschmann PU, Scheel M, Endres M, Siebert E. Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia-eclampsia and other predisposing diseases. Eur J Neurol. 2012;19(7):935–943. Available from:

Sharma A, Whitesell RT, Moran KJ. Imaging pattern of intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome. Neuroradiol. 2010;52(10):855–863. Available from:

Chen Z, Zhang G, Lerner A, Wang AH, Gao B, Liu J. Risk factors for poor outcome in posterior reversible encephalopathy syndrome: systematic review and meta-analysis. Quant Imaging Med Surg. 2018;8(4):421–432. Available from:

How to Cite
Vikrant Kanagaraju, & B Devanand. (2020). Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in Late Onset Postpartum Eclampsia- A Retrospective Study. Asian Journal of Medical Radiological Research, 8(2), 36-40.
Original Articles