Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

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