TY - JOUR T1 - PMM.47 When a fit does not fit the clinical diagnosis: seizures in pregnancy with epilepsy and pre-eclampsia……. diagnosis of Posterior Reversible Encepholopathy Syndrome (PRES) JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - A138 LP - A138 DO - 10.1136/archdischild-2014-306576.403 VL - 99 IS - Suppl 1 AU - CCM Ford AU - CI Alexander Y1 - 2014/06/01 UR - http://fn.bmj.com/content/99/Suppl_1/A138.2.abstract N2 - A 39-year-old Para 1 with known idiopathic generalised epilepsy presented at term with a short history of vomiting and visual disturbance. She was subsequently identified as having borderline hypertension with deranged renal and liver function suggesting possible pre-eclampsia. Labour was induced. In the 24 h following delivery, she developed symptoms of confusion, ataxia and diplopia. Initial head CT reported as normal. Renal, Gastroenterology and Neurology specialists reviewed and a number of diagnoses considered, including hepatic encephalopathy, infection, eclampsia and epilepsy. IV haloperidol was required. She was transferred to the Intensive Care Unit for sedation and IV Magnesium. A diagnosis of PRES was considered and head MRI was performed. This showed evidence of ischaemic changes to the brain stem and cerebellum On Day 6 she was transferred to Neurology, where she was noted to have seizure activity and dosage of anti-epileptics was increased. On Day 10 she was discharged, no longer confused but with some ataxia. Subsequent follow-up by Neurology with a repeat MRI head was normal. PRES is described as an abnormal neurological state combined with reversible MRI changes in the parieto-occipital regions of the brain, the pathophysiology of which is a form of vasogenic oedema seen in pregnancy as a variant of pre-eclampsia.. There is a spectrum of clinical presentations but PRES is important to recognise and treat in order to prevent long-term neurological deficit. ER -