Asian Journal of Medical Research and Case Reports

Posterior reversible encephalopathy syndrome is a clinicoradiological neurological disorder characterised by acute neurological symptoms and vasogenic brain oedema, most commonly involving the posterior cerebral regions. It is associated with several precipitating conditions, including hypertensive disorders of pregnancy and the postpartum state. This case report describes a 22-year-old primigravida who presented on the thirteenth postoperative day following lower-segment caesarean section with severe occipital headache, giddiness, repeated bilious vomiting, and one episode of generalised tonic–clonic seizure with postictal stupor. On admission, she had severe hypertension with a blood pressure of 180/80 mmHg, while neurological examination showed no focal deficit or meningeal signs. Laboratory evaluation showed transient renal dysfunction and neutrophilic leucocytosis. Magnetic resonance imaging of the brain revealed bilateral parieto-occipital T2/FLAIR hyperintensities with additional involvement of the right temporal lobe, left frontal lobe, and posterior limb of the left internal capsule, consistent with posterior reversible encephalopathy syndrome. Magnetic resonance venography excluded cerebral venous thrombosis. She was treated with antihypertensive therapy, anticonvulsant therapy with levetiracetam, and supportive measures, with close neurological and haemodynamic monitoring. Her headache and vomiting resolved, no further seizures occurred, renal function improved, and she was discharged in satisfactory clinical condition. This case highlights the need to consider posterior reversible encephalopathy syndrome in postpartum women presenting with severe headache, vomiting, hypertension, or seizure, even beyond the immediate puerperal period.