Akinetic Mutism due to Posterior Reversible Encephalopathy Syndrome in Pregnancy

Special Article – Neurological Rehabilitation

Phys Med Rehabil Int. 2017; 4(2): 1114.

Akinetic Mutism due to Posterior Reversible Encephalopathy Syndrome in Pregnancy

Ayas ZO¹* and Öcal RO²

¹Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey

²Department of Neurology, Baskent University, Ankara, Turkey

*Corresponding author: Zeynep Özözen Ayas, Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey

Received: April 03, 2017; Accepted: April 21, 2017; Published: April 28, 2017

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical entity diagnosed with characteristic clinical and radiological findings, which typically resolves with treatment. The prevalence of PRES in pregnancy is not clearly known. We report an unusual case who is a 27-year-old, pregnant woman presenting with seizure that was associated PRES due to eclampsia. The patient had akinetic mutism due to ischemia and edema related with PRES. In this article, we aimed to emphasize that akinetic mutism may be caused by PRES, which is a rare clinical manifestation.

Keywords: Posterior reversible encephalopathy syndrome; Akinetic mutism; Pregnancy

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by headache, vomiting, altered consciousness, seizure, and visual loss. Hypertension is the most common reason, other known causes are pre-eclampsia, eclampsia, HELLP syndrome, immunosuppressive and cytotoxic drugs, collagen vascular diseases, thrombotic thrombocytopenic purpura, use of high dose steroid, kidney and liver failure, massive blood transfusion, HIV infection, intermittent porphyria, and organ transplantation. Brain magnetic resonance imaging (MRI) shows hyperintense edema area at T2 and fluid attenuated inversion recovery (FLAIR) sections and bilateral posterior supratentorial areas typically. In this article, we report anunusual case with akinetic mutism due to PRES which is secondary to eclampsia in 26 weeks of pregnancy and review the literature.

Case Presentation

A 27-year-old, right-handed woman with 30 weeks of pregnancy presented to the emergency department with generalized tonicclonic seizures occurring twice in half an hour. It was learned that, the patient had her first seizure at home. Her second seizure had been controlled with 5mg diazepam at the hospital. According to prenatal documentation, her pregnancy was normal. Her family noted that she had headache for 2 days, but she had no any medical examination. Her blood pressure was 160/80mmHg. Her laboratory tests were normal except leukocutosis (13,7K/uL), and proteinuria in spot urine (500mg/dl). Diagnosed with eclampsia, she underwent emergency cesarean section.

Her neurological examination had akinetic mutism like as unresponsiveness with open eyes, no spontaneously speech and move in the intensive care unit. She had normal optic disc, and normal pupillary reactions, nystagmus was present falling towards the direction of her sight in her bilateral horizontal sight. She had no motor or sensory deficits with normal tendon reflexes. Computerized tomography (CT) of the brain showed a bilateral hypodensity area in occipital lobe (Figüre 1). Hyperintense edema areas were detected at the bilateral frontal, posterior parietal and occipital areas in T2 and FLAIR sections in the cranial MRI (Figüre 2). Her MRI venography was normal. The patient was treated with antiedema and antihyperintensive theraphy following PRES diagnosis. She had still akinetic mutism and apathy 24th hour later, but her nystagmus stopped. She had retrograde amnesia about last 2 days. Hypertension was controlled with intravenous glycerol trinitrate. Than she was treated with 10mg of amlodipine, 5mg of perindopril indapamid, 60mg of niphedypine, 12.5mg of carvedilol for oral medication. When her blood tension was controlled with oral medication, she was transferred from intensive care unit on the 4th day. Having no additional problem detected in the hospital, the patient was discharged with antihypertensive and anticonvulsant treatment. Her control examination one month later had no akinetic mutism and MRI findings were back to normal.

Citation: Ayas ZO and Öcal RO. Akinetic Mutism due to Posterior Reversible Encephalopathy Syndrome in Pregnancy. Phys Med Rehabil Int. 2017; 4(2): 1114. ISSN : 2471-0377