Posterior leukoencephalopathy syndrome: Postpartum focal neurologic deficits: A report of three cases and review of the literature
A 35-year-old woman, G2 P1, at 39 weeks’ gestation, was admitted to the emergency department with labor work. Her medical record showed no significant disease and her prenatal history was unremarkable. An epidural catheter was placed and epidural analgesia was administered. The blood test was normal. During labor, her systolic blood pressure remained high, with values of 170/90 mmHg being recorded. This blood pressure persisted and intravenous 5 mg hydralazine was administered. A 2700 g newborn was delivered alive with Apgar scores of 7 at 10 min. The umbilical cord pH was 7.26. He was transferred to a pediatric clinic where appropriate resuscitation was performed.\nThe patient was transferred to the obstetric ward 2 h after delivery, with persisting high blood pressure and headache. Alphamethyldopa 500 mg orally was administered to control arterial pressure, but, 20 min later, the patient had a seizure and intravenous 10 mg of diazepam was administered to control the same. The patient recovered, presenting confusion, and was then admitted to the PACU with stupor, without focal neurological and mild lower limb edema. A cranial CT scan was performed, which showed findings consistent with posterior reversible encephalopathy []. In the laboratory blood test, the hemoglobin, platelet count and prothrombin activity were 11.7 mg/dL, 67,000 × 109/L and 60%, respectively. The patient also presented elevated liver enzymes and proteinuria. Elevated blood pressure persisted, requiring intravenous infusion of labetalol (25 mg bolus dose over 2-5 min). An intravenous infusion of magnesium sulfate was also initiated for 24 h. At 48 h, the intravenous infusions were suspended and oral treatment was initiated with amlodipine 10 mg/day and irbesartan 300 mg/day.\nBecause of the improvement of patient, she was transferred to the gynecology ward on the third day. Five days later, an MRI was performed. Results were normal. The patient was discharged without any neurological deficits.