Objective: To describe a rare presentation of acute secondary parkinsonism in the post partum period.

Background:  Background Posterior encephalopathy syndrome [PRES] is a rare complication seen in the peri-partum period in females.

Methods: We describe a case of a 25 year old primigravida patient who presented with acute symmetric bradykinesia associated with headache and vomiting at 10 days postpartum. Her Magnetic Resonance Imaging revealed bilateral symmetric ischemic areas in the basal ganglia and subcortical region along with features of posterior reversible encephalopathy syndrome. Her cerebrospinal fluid, HIV, VDRL, ANA, APLA, ANCA , hepatic, renal functions and electrolytes were all normal. She did not have hypertension, diabetes, dyslipidemia, any procoagulant states or consumption of any drugs or medicines.

Results: A diagnosis of secondary parkinsonism secondary to basal ganglia dysfunction in the setting of PRES in the post partum period was considered. On observing for 5 subsequent days, there was no improvement in her bradykinesia or rigidity. An empiric trial of levodopa in a dose of 125 mg , three times a day was started. There was marked improvement in her bradykiesia and rigidity 2 days after the treatment. A transient withholding of levodopa lead to reappearance of bradykinesia and rigidity. Restarting levodopa again lead to recovery. A repeat MRI done at 4 weeks post onset revealed complete resolution of the initial findings. Levodopa was tapered off subsequently without recurrence of symptoms.

Conclusions: We describe a rare case of levodopa responsive reversible transient secondary parkinsonism in the setting of PRES in the post partum period.

This case report was presented before at AOPMC 2016, Manila. It has not been published yet.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rare-presentation-of-acute-secondary-parkinsonism-in-the-post-partum-period/