Surgery or Not? A Retrospective Observational Study in Eclamptic Patients with Malignant Posterior Reversible Encephalopathy Syndrome and Intracerebral Hemorrhage.

Abstract

The study aims to evaluate the outcomes of surgical intervention in eclamptic patients with malignant posterior reversible encephalopathy syndrome (PRES) complicated by intracerebral hemorrhage (ICH). A retrospective review of 22 eclamptic women diagnosed with PRES between January 2013 and November 2023 was conducted. Patients were categorized into 4 groups: group 1 (no ICH, Glasgow Coma Scale 15, and no signs of increased intracranial pressure [IICP]), group 2 (no ICH, Glasgow Coma Scale <15, with neurological deficits), group 3 (ICH <10 ml, no mass effect, and no signs of IICP), and group 4 (ICH >10 ml, with mass effect and signs of IICP). Patient demographics, obstetrical outcomes, radiological findings, and functional recovery (measured by modified Rankin Scale [mRS]) were analyzed. No patients in groups 1 or 2 required surgery, while all patients in group 4 underwent surgical intervention. At presentation, group 4 exhibited significantly worse mRS scores (mean 4.4) compared to groups 1 (mean 1.2) and 2 (mean 2.29, P < 0.001). However, at the 1- and 2-year follow-ups, mRS scores were comparable across all groups (P = 0.458 and P = 0.883, respectively), reflecting substantial recovery regardless of initial severity. Eclamptic women with malignant PRES and ICH can achieve long-term outcomes comparable to those without hemorrhagic transformation through timely surgical intervention following American Heart Association guidelines, though the natural course of such cases remains unclear.