Cranial MRI Findings of Severe HELLP Syndrome Treated With Plasmapheresis

We present a case of severe postpartum HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome associated with central nervous system symptoms. Cerebral manifestations of HELLP syndrome and relevant radiological findings were discussed. Microvascular endothelial damage causes hemolysis of red blood cell and subsequent thrombosis occurs in the pathophysiology of syndrome. Diffuse symmetric hyperintensities in bilaterally basal ganglions, fronto-parieto-occipital cortical and subcortical white matter were illustrated on T2 weighted magnetic resonance imaging (MRI) of our case. Diffusion weighted images showed that these abnormalities are areas of vasogenic edema accompanied by focal cytotoxic edema with diffusion restriction. Plasma exchange was resulted in a steady improvement. This case illustrates the potential importance of early diagnosis with diffusion weighted imaging and management of pregnancy-related thrombotic microangiopathy for better neurological outcome.