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Posterior reversible encephalopathy syndrome, preeclampsia or stroke? A diagnostic dilemma
  1. Vikesh Patel1,
  2. Bhavna Ramachandran2 and
  3. Ifrah Omar1
  1. 1 Department of Obstetrics and Gynaecology, Lister Hospital, Stevenage, UK
  2. 2 School of Clinical Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Vikesh Patel, vikesh.patel{at}


When a pregnant woman presents with headaches, visual disturbances, epigastric pain and nausea, preeclampsia quickly springs to mind. This case describes a primigravid 22-year-old female of 32 weeks gestation who presented with the symptoms described but was found to be apparently normotensive. Due to ongoing symptoms and diagnostic uncertainty in the absence of definitive evidence of preeclampsia, the patient was further investigated with an MRI brain scan, which was reported as either an acute stroke or an atypical presentation of posterior reversible encephalopathy syndrome. Together with blood results that showed heterozygosity for Factor V Leiden, we concluded that while the patient’s clinical diagnosis was certainly preeclampsia, her investigations also supported an unexpected diagnosis of silent brain infarction. This report outlines a diagnostic dilemma that required multidisciplinary working between obstetricians, neurologists, radiologists and stroke physicians to manage the patient who went on to make a full recovery and deliver a healthy baby.

  • stroke
  • obstetrics and gynaecology
  • pregnancy
  • haematology (incl blood transfusion)
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  • Contributors VP was involved in the patient’s care, the conception and collection of the information and in the writing and revising of the article. BR was involved in the writing of the article. IO was involved in the patient’s care, consenting the patient and in the writing of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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