• Sheng-Han Huang, Kuan-Hao Fu, Cheng-Yu Li, Tzu-Chin Lin, Pin-Yuan Chen, and Ying-Ching Li.
• Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
• World Neurosurg. 2025 Jan 29: 123739123739.

ObjectiveThe study aims to evaluate the outcomes of surgical intervention in eclamptic patients with malignant posterior reversible encephalopathy syndrome (PRES) complicated by intracranial hemorrhage (ICH).MethodsA retrospective review of 22 eclamptic women diagnosed with PRES between January 2013 and November 2023 was conducted. Patients were categorized into four groups: Group 1 (no ICH, GCS 15, and no signs of increased intracranial pressure [IICP]), Group 2 (no ICH, GCS <15, with neurological deficits), Group 3 (ICH <10 ml, no mass effect, and no signs of IICP), and Group 4 (ICH >10 ml, with mass effect and signs of IICP). Patient demographics, obstetrical outcomes, radiological findings, and functional recovery (measured by mRS) were analyzed.ResultsNo patients in Groups 1 or 2 required surgery, while all patients in Group 4 underwent surgical intervention. At presentation, Group 4 exhibited significantly worse mRS scores (mean 4.4) compared to Groups 1 (mean 1.2) and 2 (mean 2.29, p<0.001). However, at the 1- and 2-year follow-ups, mRS scores were comparable across all groups (p=0.458 and p=0.883, respectively), reflecting substantial recovery regardless of initial severity.ConclusionEclamptic women with malignant PRES and ICH can achieve long-term outcomes comparable to those without hemorrhagic transformation through timely surgical intervention following AHA guidelines, though the natural course of such cases remains unclear.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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