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In rare cases, eclampsia, defined as perinatal seizures in pre-eclampsia (hypertension, >140/90 mm Hg; proteinuria, >1+ qualitatively; edema, >20th week of gestation),1 is associated with the posterior reversible encephalopathy syndrome (PRES).2 PRES is attributed to a vasogenic edema of unknown pathomechanism in the posterior circulation territories.3 Whether the vasodilator nitroglycerin aggravates the edema in patients with eclamptic PRES is unknown.
Case report.
A 27-year-old woman, gravida 2, para 1, developed pre-eclampsia at week 35 of gestation. The history for hypertension, renal insufficiency, and paternity change was negative. Prepregnancy blood pressure was 120/85 mm Hg. Elevated blood pressure at week 36 of gestation prompted hospitalization (blood pressure on admission, 170/120 mm Hg) and, because of intractability, urgent cesarean section on hospital day 5 (presurgery blood pressure, 156/112 mm Hg). Six hours after cesarean section, she developed diffuse headache, associated with blood pressure values up to 177/115 mm Hg. For hypertension she received urapidil and metoprolol, with minimal effect. On hospital day 6, diffuse headache recurred, and because blood pressure was 177/119 mm Hg, 2 heaves of nitroglycerin (0.8 mg) were given …
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