Posterior Reversible Encephalopathy Syndrome with Stroke in Puerperal Woman with High Titer of Anti-Phospholipid IgM Antibody

Abstract EN

Posterior reversible encephalopathy syndrome with stroke is very rare in puerperal women.

A 36-year-old nulliparous woman with both rheumatoid arthritis and recurrent pregnancy loss, probably due to a high titer of anti-phospholipid IgM antibody, was referred at 10 weeks of gestation.

Low-dose aspirin at 100 mg/day and heparin calcium subcutaneous injection at 10,000 units/day were started before pregnancy and stopped at 35+6 and 40+2 weeks, respectively.

She transabdominally delivered a male infant weighing 3,344 g at 40+5 weeks.

A tonic-clonic seizure abruptly occurred without either hypertension or proteinuria 5 days after delivery.

Intracerebral hemorrhage involving an area of 2 cm in diameter in the right frontal lobe and subarachnoid hemorrhage with PRES were confirmed.

Seizure recurred 2 days after the initial episode.

She showed severe headache and mild disturbance of consciousness but no neurological findings.

We suggested that a high titer of anti-phospholipid IgM antibody might be associated with stroke.