Case in Point Solution

This patient was diagnosed with the cortical blindness of pre-eclampsia, a form of PRES. With modern imaging, the incidence is 1–3 percent in pre-eclampsia, and 3–14 percent in eclampsia (Am J Obstet Gynecol 1995;1291–1298). Patients often have headache, and blindness may be prolonged, up to 34±27 hours in eclampsia and 92±67 hours in pre-eclampsia. Abnormal MRI signal intensities in the occipital lobes can persist after vision returns to normal (Survey Ophthalmol 2003;48(6):647–650). The distribution of lesions is attributed to relative reduction of sympathetic afferents in the posterior circulation (Neurology 2001;56(3):388–391). In pregnant patients with eclampsia or pre-eclampsia with cerebral blindness, this reversible and treatable diagnosis should be considered.

©2006 American Academy of Neurology