Postpartum consciousness disturbance: can covid-19 cause posterior reversible encephalopathy syndrome? / Alteración del nivel de conciencia puerperal: ¿puede el COVID-19 ser causa de síndrome de encefalopatía posterior reversible?

We describe the case of a 24-year-old pregnant woman with no history of note who was admitted with a diagnosis of bilateral pneumonia caused by the new coronavirus. Due to clinical worsening, she required urgent cesarean section with general anaesthesia and intubation for decubitus intolerance. After extubation, she presented altered mental state that required a differential diagnosis of encephalitis/meningitis secondary to SARS-CoV-2. CT and CT-angiography were normal, spinal fluid tests were non-specific, and magnetic resonance imaging reported posterior reversible encephalopathy syndrome (PRES) (due to radiological features suggestive of white matter vasogenic edema affecting the parietal, temporal and occipital lobes, along with altered mental state) secondary to gestational hypertension. Eleven days after the cesarean section the patient began to develop hypertension that required treatment. PRES is associated with certain clinical (headache, altered mental state, visual disturbances and convulsions) and radiological (reversible changes in white substance mainly affecting the parietal, temporal, and occipital lobes) characteristics suggestive of vasogenic oedema In pregnant SARS-CoV-2 patients, the differential diagnosis of hypertension and altered mental state is often extremely complicated because complementary tests can be normal and there is no immediate sign of peripartum hypertension. SARS-CoV-2 genome sequencing in spinal fluid could have provided a definitive diagnosis, but the treatment would not have differed.

Alteración del nivel de conciencia puerperal: ¿puede el COVID-19 ser causa de síndrome de encefalopatía posterior reversible? / Postpartum consciousness disturbance: can covid-19 cause posterior reversible encephalopathy syndrome?

Describimos el caso de una gestante de 24 años de edad, sin enfermedades previas, que fue ingresada con diagnóstico de neumonía bilateral por el nuevo coronavirus 2. Por empeoramiento clínico precisó cesárea urgente con anestesia general e intubación orotraqueal por intolerancia al decúbito. Tras la extubación desarrolló un cuadro de obnubilación que obligó al diagnóstico diferencial de encefalitis/meningitis por SARS-CoV-2, con tomografía computarizada (TC) y angioTC normales, bioquímica del líquido cefalorraquídeo (LCR) inespecífica y resonancia magnética informada como «síndrome de encefalopatía posterior reversible» (al presentar características radiológicas sugestivas de edema vasogénico con alteraciones en la sustancia blanca de localización parieto-temporo-occipital, junto con alteración de nivel de conciencia) secundaria a cuadro hipertensivo del embarazo. La paciente 11 días después de la cesárea comenzó a desarrollar un cuadro hipertensivo que requirió tratamiento. La encefalopatía posterior reversible (PRES) asocia un conjunto de características clínicas (cefalea, alteración del nivel de conciencia, alteraciones visuales y convulsiones) y radiológicas (alteraciones reversibles en la sustancia blanca fundamentalmente en regiones parieto-temporo-occipitales) sugestivas de edema vasogénico. En pacientes gestantes SARS-CoV-2, el diagnóstico diferencial de la patología hipertensiva y las alteraciones de nivel de conciencia puede ser extremadamente complicado, al encontrarnos pruebas complementarias normales y ausencia de hipertensión arterial (HTA) en el periparto inmediato. Tal vez la secuenciación del genoma del SARS-CoV-2 en el LCR nos hubiera permitido un diagnóstico de certeza, aunque el tratamiento no hubiera variado

We describe the case of a 24-year-old pregnant woman with no history of note who was admitted with a diagnosis of bilateral pneumonia caused by the new coronavirus. Due to clinical worsening, she required urgent cesarean section with general anaesthesia and intubation for decubitus intolerance. After extubation, she presented altered mental state that required a differential diagnosis of encephalitis/meningitis secondary to SARS-CoV-2. CT and CT-angiography were normal, spinal fluid tests were non-specific, and magnetic resonance imaging reported posterior reversible encephalopathy syndrome (PRES) (due to radiological features suggestive of white matter vasogenic edema affecting the parietal, temporal and occipital lobes, along with altered mental state) secondary to gestational hypertension. Eleven days after the cesarean section the patient began to develop hypertension that required treatment. PRES is associated with certain clinical (headache, altered mental state, visual disturbances and convulsions) and radiological (reversible changes in white substance mainly affecting the parietal, temporal, and occipital lobes) characteristics suggestive of vasogenic oedema In pregnant SARS-CoV-2 patients, the differential diagnosis of hypertension and altered mental state is often extremely complicated because complementary tests can be normal and there is no immediate sign of peripartum hypertension. SARS-CoV-2 genome sequencing in spinal fluid could have provided a definitive diagnosis, but the treatment would not have differed