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\title{A Case of Transient Cortical Blindness in Posterior Reversible Encephalopathy Syndrome in the Late Postpartum Period}
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\begin{document}

             \author[1]{Dr. Krishna K  Nair}

             \author[2]{Dr. Jayanthi  R}

             \author[3]{Dr. Sahitya  Medal}

             \affil[1]{  Meenakshi medical college hospital and research institute}

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\date{\small \em Received: 7 December 2019 Accepted: 1 January 2020 Published: 15 January 2020}

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\begin{abstract}
        


Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by seizure, headaches, visual symptoms, impaired consciousness and other focal neurological findings. It is caused by a wide variety of causes ultimately leading to vasogenic cerebral oedema of occipital and parietal lobes of the brain. The pathophysiology is failure of cerebral a utoregulationand endothelial dysfunction

\end{abstract}


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\section[{Introduction}]{Introduction}\par
osterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by seizure, headaches, visual symptoms, impaired consciousness and other focal neurological findings.\par
It is caused by a wide variety of causes ultimately leading to vasogenic cerebral oedema of occipital and parietal lobes of the brain.\par
The pathophysiology is failure of cerebral autoregulationand endothelial dysfunction. Intraoperative and postoperative period was uneventful. no H/O undue bleeding in the postpartum period. She was breastfeeding her newborn. On examination: patient was conscious, alert and oriented. she was found to have elevated BP-180/100mmhg.Rest of the vital signs were within normal limits. Systemic examination was done no abnormalities were detected. 
\section[{II.}]{II.} 
\section[{Case Presentation}]{Case Presentation}\par
Power was 5/5 in all 4 limbs. sensory function was intact .cranial nerve examination was unremarkable. cerebral signs were intact. no signs of neck rigidity. plantars were B/L flexors.\par
On ocular examination, visual acuity of both the eyes were 1/60 with bilateral pupils reacting well to the light with normal fundus. Treatment: The patient was transferred to the intensive care unit. LABETALOL infusion was started at a rate of 1mg/min with close monitoring of blood pressure. Patient's symptoms gradually resolved and her vision improved to 6/6 after 8 hours.\par
Her Blood pressure was maintained at 130/80mmhg and Labetalol infusion was stopped and was started on Tab. Amlodipine 5 mg 12 th hourly.\par
Patient continued to improve clinically and was discharged on 5 th day of hospitalization. She was prescribed Tab. Amlodipine 2.5mg BD. 
\section[{III.}]{III.} 
\section[{Discussion}]{Discussion}\par
Posterior reversible encephalopathy syndrome (PRES) was first described by \hyperref[b0]{Hinchey et al. in 1996.} It is a reversible neurological entity characterized by the presence of white matter oedema affecting the occipital and parietal lobes. It can occur at any age and most commonly affects female.\par
A variety of clinical conditions are associated with the development of PRES, which include hypertensive emergency, renal disease, pre-eclampsia/ eclampsia, immunosuppressive agents, sepsis, auto immune disease.\par
MRI is the imaging modality of choice. Diffusion-weighted MRI helps to distinguish the Vasogenic oedema from cytotoxic oedema. Permanent neurological impairment or death occurs only in a minority of patients. Recurrence of symptoms has been observed in 8\% of the cases. 
\section[{IV.}]{IV.} 
\section[{Conclusion}]{Conclusion}\par
As indicated by its name, appropriate treatment is expected to ensure a full recovery. MRI of the brain is crucial to make the diagnosis.\par
The management of PRES involves early diagnosis, treatment of the symptomatology and correction of the causative factor.\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}A}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{5}\includegraphics[]{image-3.png}
\caption{\label{fig_1}Investigations: 5 .}\end{figure}
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\end{bibitemlist}
 			 		 	 
\end{document}
