Clinical analysis of four cases of postpartum posterior reversible encephalopathy syndrome which mimics cerebral venous sinus thrombosis

Objective To investigate the clinical and radiologic features of postpartum posterior reversible encephalopathy syndrome (PRES) and provide the clues for differentiation from cerebral venous sinus thrombosis (CVST). Methods Four cases of postpartum PRES were retrospectively studied based on clinical, radiologic features and treatment. Results All of four cases presented with headache, nausea, vomiting, seizures and hypertension. Three of them presented visual disturbances, one of whom was found bilateral retinal detachment. Magnetic resonance imaging (MRI) revealed bilateral parieto-occipital long T1 and T2 lesions, which mainly located in subcortical regions. Anticoagulant drugs were applied in two cases, while two other cases underwent strict control of blood pressure. The clinical presentation and radiologic features were all improved markedly in the four cases, except blurred vision left in one case. Conclusions The clinical and radiological manifestations of PRES can be similar to CVST. CVST should be excluded based on the characteristic clinical and radiologic features of PRES in the early stage, especially when patients have poor visualization of sinus flow on MRI. Key words: Posterior leukoencephalopathy syndrome; Sinus thrombosis, intracranial; Magnetic resonance imaging