From Headache to PRES: Early Recognition of Preeclampsia in a Pregnant Patient

Abstract

Early neuroimaging should be strongly considered in pregnant patients presenting with any neurological symptoms, even when symptoms appear minor, such as headache, as this may enable timely detection of serious underlying conditions. Delaying intervention until the onset of seizures risks missing early indicators of life-threatening complications such as Posterior Reversible Encephalopathy Syndrome (PRES), which can serve as a premonitory sign of advancing eclampsia, particularly in the setting of preeclampsia. This case report illustrates that clinical principle through the presentation of a 29-year-old Saudi woman, gravida 2 para 1, at 33+4 weeks of gestation, who arrived at obstetric triage with a three-day history of progressively worsening fronto-occipital headache. Her presentation was complicated by neurological findings including confusion and bilateral ankle clonus—hallmarks of neurological irritability—later confirmed as PRES via classic MRI features. Management involved urgent blood pressure control, administration of magnesium sulfate for seizure prophylaxis, and expedited delivery due to both high-risk maternal status and signs of severe fetal compromise on Doppler and non-stress testing. This case is unique in demonstrating how subtle early neurological symptoms can unmask severe pathology, and it underscores the critical importance of multidisciplinary vigilance in preventing maternal and fetal morbidity; it offers valuable clinical insights into the timely recognition and management of PRES in the context of hypertensive disorders of pregnancy.