{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:10:01Z","timestamp":1756375801786,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,9]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>When a pregnant woman presents with headaches, visual disturbances, epigastric pain and nausea, preeclampsia quickly springs to mind. This case describes a primigravid 22-year-old female of 32\u2009weeks gestation who presented with the symptoms described but was found to be apparently normotensive. Due to ongoing symptoms and diagnostic uncertainty in the absence of definitive evidence of preeclampsia, the patient was further investigated with an MRI brain scan, which was reported as either an acute stroke or an atypical presentation of posterior reversible encephalopathy syndrome. Together with blood results that showed heterozygosity for Factor V Leiden, we concluded that while the patient\u2019s clinical diagnosis was certainly preeclampsia, her investigations also supported an unexpected diagnosis of silent brain infarction. This report outlines a diagnostic dilemma that required multidisciplinary working between obstetricians, neurologists, radiologists and stroke physicians to manage the patient who went on to make a full recovery and deliver a healthy baby.<\/jats:p>","DOI":"10.1136\/bcr-2019-230281","type":"journal-article","created":{"date-parts":[[2019,7,27]],"date-time":"2019-07-27T11:46:36Z","timestamp":1564227996000},"page":"e230281","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Posterior reversible encephalopathy syndrome, preeclampsia or stroke? A diagnostic dilemma"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8298-9232","authenticated-orcid":false,"given":"Vikesh","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Lister Hospital, Stevenage, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1017-3530","authenticated-orcid":false,"given":"Bhavna","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ifrah","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Lister Hospital, Stevenage, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,27]]},"reference":[{"key":"2025082802555587000_12.7.e230281.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602223340803"},{"key":"2025082802555587000_12.7.e230281.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00111-8"},{"key":"2025082802555587000_12.7.e230281.3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.carj.2016.08.005","article-title":"Posterior reversible encephalopathy syndrome: a review","volume":"68","author":"Shankar","year":"2017","journal-title":"Can Assoc Radiol J"},{"key":"2025082802555587000_12.7.e230281.4","doi-asserted-by":"crossref","first-page":"5376","DOI":"10.4081\/ni.2014.5376","article-title":"Posterior reversible encephalopathy syndrome: differences between pregnant and non-pregnant patients","volume":"6","author":"Marrone","year":"2014","journal-title":"Neurol Int"},{"key":"2025082802555587000_12.7.e230281.5","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2007.066167"},{"key":"2025082802555587000_12.7.e230281.6","doi-asserted-by":"publisher","DOI":"10.1097\/GIM.0b013e3181faa0f2"},{"key":"2025082802555587000_12.7.e230281.7","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1160\/TH09-01-0013","article-title":"The genetics of venous thromboembolism. A meta-analysis involving approximately 120,000 cases and 180,000 controls","volume":"102","author":"Gohil","year":"2009","journal-title":"Thromb Haemost"},{"issue":"s1","key":"2025082802555587000_12.7.e230281.8","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/j.1538-7836.2009.03394.x","article-title":"Genetics of venous thrombosis","volume":"7 Suppl 1","author":"Rosendaal","year":"2009","journal-title":"J Thromb Haemost"},{"key":"2025082802555587000_12.7.e230281.9","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000170635.45745.b8"},{"key":"2025082802555587000_12.7.e230281.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g3175"},{"key":"2025082802555587000_12.7.e230281.11","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70170-9"},{"key":"2025082802555587000_12.7.e230281.12","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011889"},{"key":"2025082802555587000_12.7.e230281.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022066"},{"key":"2025082802555587000_12.7.e230281.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0100789","article-title":"Association between thrombophilia gene polymorphisms and preeclampsia: a meta-analysis","volume":"9","author":"Wang","year":"2014","journal-title":"PLoS One"},{"key":"2025082802555587000_12.7.e230281.15","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1160\/TH07-12-0754","article-title":"Ischaemic stroke patients with heterozygous factor V Leiden present with multiple brain infarctions and widespread atherothrombotic disease","volume":"101","author":"Haapaniemi","year":"2009","journal-title":"Thromb Haemost"},{"key":"2025082802555587000_12.7.e230281.16","unstructured":"Royal College of Obstetricians & Gynaecologists. Thrombosis and embolism during pregnancy and the puerperium, reducing the risk (Green-top Guideline No. 37a). 2015 https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/gtg-37a.pdf (Accessed Jun 2018)."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:56:03Z","timestamp":1756374963000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7]]},"references-count":16,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7,27]]},"published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1136\/bcr-2019-230281"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230281","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,7]]}}}