A 23-year-old primigravida with severe pre-eclampsia delivers at 33 weeks. Twelve hours postpartum she reports she cannot see. Examination shows reactive pupils, normal fundi, and intact extraocular movements. MRI reveals T2 hyperintensity with vasogenic oedema in bilateral occipital and parietal white matter. What is the most likely diagnosis?

• A Central retinal artery occlusion
• B Reversible posterior leukoencephalopathy syndrome ✓
• C Occipital lobe infarction from embolic stroke
• D Retrobulbar optic neuritis

Explanation

Cortical blindness in severe pre-eclampsia and eclampsia reflects reversible posterior leukoencephalopathy syndrome, caused by vasogenic oedema from failed cerebral autoregulation and endothelial injury, typically in occipital and parietal regions. Reactive pupils and normal fundi distinguish it from retinal and optic nerve lesions. The imaging pattern and full reversibility after blood pressure control separate it from infarction, which produces restricted diffusion and permanent deficit.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.