Brain MRI findings of a 24-week pregnant woman with HELLP syndrome
Mehtap Beker-Acay 1  
,   Serdar Unlu 2,   Nazan Okur 2,   Ebru Unlu 1,   Aylin Yucel 1
More details
Hide details
Department of Radiology, Faculty of Medicine, Afyon Kocatepe University, Turkey
Department of Obstetrics and Gynecology, Faculty of Medicine, Afyon Kocatepe University, Turkey
Mehtap Beker-Acay   

Department of Radiology, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey. Tel.: +90 2722463303; fax: +90 2722463300.
Submission date: 2014-12-10
Acceptance date: 2015-05-04
Online publication date: 2015-07-09
Publication date: 2020-03-23
Pol. Ann. Med. 2016;23(1):34–38
HELLP syndrome (acronym comprised of hemolysis, elevated liver enzymes and low platelets) is seen in 0.1% of pregnant women. Posterior reversible encephalopathy syndrome (PRES) was reported to be 5% in patients with the HELLP syndrome. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI.

We aimed to improve clinicians' perception about brain lesions in the HELLP syndrome with imaging findings.

Case study:
Here, we present a case of an 18-year-old patient with a pregnancy of 24 weeks admitted with HELLP syndrome, with CT and MRI findings of PRES and intracerebral hematoma. MRI scan of the brain showed vasogenic edema in the occipital, frontal and parietal lobes bilaterally, basal ganglia and brainstem. An emergency cesarean section was successfully performed to end the pregnancy on the same day. Repeat MRI of the brain three days after initial admission showed partial improvement of the previous abnormalities with full clinical recovery.

Results and discussion:
The patient in this report had a variant form of PRES where the pathologic process encompassed both the posterior and anterior circulations.

An appropriate multidisciplinary approach is the key for reducing the morbidity and mortality of PRES syndrome.

None declared.
Okada T, Kanagaki M, Yamamoto A, Fushimi Y, Togashi K. Magnetic resonance imaging of vascular encephalopathy related to pregnancy. Neurol Med Chir (Tokyo). 2013;53(8):520–525.
Ekawa Y, Shiota M, Tobiume T, et al. Reversible posterior leukoencephalopathy syndrome accompanying eclampsia: correct diagnosis using preoperative MRI. Tohoku J Exp Med. 2012;226(1):55–58.
Stevens CJ, Heran MK. The many faces of posterior reversible encephalopathy syndrome. Br J Radiol. 2012;85(1020):1566–1575.
Paul BS, Juneja SK, Paul G, Gupta S. Spectrum of neurological complications in HELLP syndrome. Neurol India. 2013;61(5):467–471.
Iwashita Y, Kan'o T, Hattori J, et al. A case of HELLP syndrome with multiple complications. Intern Med. 2012;51(16):2227–2230.
Yoon SD, Cho BM, Oh SM, Park SH, Jang IB, Lee JY. Clinical and radiological spectrum of posterior reversible encephalopathy syndrome. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):206–213.
Moon SN, Jeon SJ, Choi SS, et al. Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)? Acta Radiol. 2013;54(10):1182–1190.
McKinney AM, Jagadeesan BD, Truwit CL. Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema. AJR Am J Roentgenol. 2013;201(3):631–638.
McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189(4):904–912.
Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol. 2009;30:1371–1379.
Legriel S, Schraub O, Azoulay E, et al. Determinants of recovery from severe posterior reversible encephalopathy syndrome. PLoS One. 2012;7(9):e44534.
Aukes AM, De Groot JC, Wiegman MJ, Aarnoudse JG, Sanwikarja GS, Zeeman GG. Long-term cerebral imaging after pre-eclampsia. BJOG. 2012;119(9):1117–1122.