1/17. Late postpartum eclampsia 16 days after delivery: case report with clinical, radiologic, and pathophysiologic correlations.BACKGROUND: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. RESULTS AND CONCLUSIONS: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
2/17. Assessment of vasogenic edema in eclampsia using diffusion imaging.We qualitatively assessed the regional distribution of vasogenic edema in a case of postpartum eclampsia. Although diffusion-weighted imaging showed no abnormalities, bilateral high signal was seen on T2-weighted images and apparent diffusion coefficient (ADC) maps. ADC of 1.45 /- 0.10 mm2/s x 10(-3) for the posterior cerebral artery (PCA) territory and 1.22 /- 0.12 mm2/s x 10(-3) for the watershed areas were significantly higher than those in the territories of the anterior (0.85 /- 0.07 mm2/s x 10(-3) and middle cerebral (0.79 /- 0.06 mm2/s x 10(-3)) arteries (P < 0.05). The predilection of ADC changes within the PCA territory and in a previously undescribed watershed distribution supports the hypothesis that vasogenic edema in eclampsia is due to hypertension-induced failure of vascular autoregulation.- - - - - - - - - - ranking = 0.5keywords = posterior (Clic here for more details about this article) |
3/17. Reversible posterior leukoencephalopathy syndrome: a report of 2 cases.Reversible posterior leukoencephalopathy syndrome (RPLE) is an increasingly recognised disorder, most commonly associated with malignant hypertension, toxaemia of pregnancy or the use of immunosuppressive agents. Two cases of RPLE syndrome occurring in the setting of accelerated hypertension and eclampsia are described. Both patients had seizures, altered sensorium and typical findings on neuroimaging. They had complete clinical and radiological recovery. The clinical course, pathophysiology and neuroimaging features of RPLE syndrome are discussed.- - - - - - - - - - ranking = 7877.6513193392keywords = leukoencephalopathy syndrome, posterior leukoencephalopathy syndrome, posterior leukoencephalopathy, leukoencephalopathy, posterior (Clic here for more details about this article) |
4/17. angioplasty for cerebral vasospasm from eclampsia.BACKGROUND: Neurological deterioration in eclampsia is considered to be secondary to cerebral vasospasm. magnesium sulfate therapy improves symptoms and controls seizures, possibly related to its vasorelaxive effects in spastic arteries. Some cases, however, are refractory to magnesium therapy. To our knowledge, there is no report of angioplasty for vasospasm from eclampsia in the literature. methods: A 27-year-old woman presented 10 days postpartum with severe mental status changes and left arm and bilateral leg weakness that were refractory to magnesium therapy. cerebral angiography demonstrated diffuse, severe vasospasm. We treated her with angioplasty of the bilateral middle and posterior cerebral arteries, basilar artery, and bilateral internal carotid arteries. RESULTS: angioplasty resulted in excellent angiographic improvement. The patient immediately became responsive and appropriate with improved strength in all extremities. She continued to improve throughout her hospital stay and was discharged 10 days postangioplasty. CONCLUSIONS: Cerebral angioplasty is an effective treatment for vasospasm from eclampsia refractory to magnesium therapy. Angiography should be considered early in the course of neurological deterioration, but delayed therapy may also be effective.- - - - - - - - - - ranking = 0.5keywords = posterior (Clic here for more details about this article) |
5/17. Post-partum cerebral angiopathy: repetitive TCD, MRI, MRA, and EEG examinations.We report of a woman with post-partum cerebral angiopathy (PCA), in whom we repetitively performed transcranial Doppler sonography (TCD), MR imaging (MRI), and MR angiography (MRA) to evaluate the underlying pathophysiology. A 31-year-old woman, Gemini pregnant, complained of severe throbbing frontal headache four days after an uneventful delivery by cesarean section. Blurred vision occurred eight days after delivery, followed by three generalized tonic-clonic seizures. Neurological examination revealed a somnolent woman without focal neurological deficits. At the day of the seizures increased flow velocities and disturbed flow were observed in the right posterior and anterior cerebral artery on transcranial Doppler (TCD). MRI showed infra- and supratentorial patchy hyperintensities in T2-weighted images and in the FLAIR sequence. diffusion-weighted imaging revealed corresponding multi-focal hyperintense areas indicating increased diffusion and MRA showed a diffuse multisegmental narrowing of all pial arteries. MRI at day 10 was completely normal, but MRA still revealed vascular narrowing in the right posterior cerebral artery. General slight flow accelerations in all basal arteries occurred after 10 days and lasted for three weeks. PCA is apparently associated with a vascular narrowing causing cerebral ischemia with increased diffusion. Later reactive cerebral hyperperfusion is observed. Vascular narrowing and cerebral hyperperfusion still persist after MRI has normalized.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
6/17. Visually guided reaching: bilateral posterior parietal lesions cause a switch from fast visuomotor to slow cognitive control.The visually guided reaching of two patients with bilateral optic ataxia was explored in two experiments. In Experiment 1 simple delayed pointing was compared with immediate pointing. In the immediate pointing task both variable and constant errors increased with target eccentricity. In contrast to the performance of control subjects and contrary to their own beliefs, the patients both showed improved accuracy in the delay condition. This improvement was manifest as a reduction in both pointing variability and in the constant angular error towards the point of fixation. Both angular errors and their improvement with the delay were proportional to target eccentricity. Experiment 2 used a task in which the target was pre-viewed 5s prior to its re-exposure for pointing ('delayed real pointing'). On some trials a conflict was introduced between the present and previous visual information by changing the target's location during the delay. In contrast to control subjects, who ignored the pre-viewed location and aimed directly at the current target, both patients with optic ataxia initiated their movements towards the previously viewed target location. Evidently they relied on off-line information in preference to on-line visual information. In addition, the patients often failed to detect the changes in target location. One of the patients sometimes even guessed incorrectly that the target had changed its location, and her movement trajectory was then more affected by her false belief than by the target's actual location. These findings confirm that posterior parietal lesions severely disrupt direct visuomotor transformations, and suggest that the residual performance is mediated indirectly by expectations or beliefs about target position.- - - - - - - - - - ranking = 2.5keywords = posterior (Clic here for more details about this article) |
7/17. Postpartum focal neurologic deficits: posterior leukoencephalopathy syndrome.The postpartum patient who presents with focal neurologic deficits presents a wide range of diagnostic possibilities. We report the case of a previously healthy woman who presented 7 days postpartum with a focal deficit and who was ultimately diagnosed with eclampsia and posterior leukoencephalopathy syndrome (PLES). The hallmark of this entity is reversible parieto-occipital white matter edema as seen on magnetic resonance imaging (MRI). Advanced MRI techniques, such as echo-planar diffusion-weighted images and apparent diffusion coefficient maps, suggest cerebral artery dilatation as the underlying mechanism. Laboratory findings and computed tomography (CT) scans are typically unremarkable. PLES has a favorable prognosis if treated promptly and appropriately.- - - - - - - - - - ranking = 7877.6513193392keywords = leukoencephalopathy syndrome, posterior leukoencephalopathy syndrome, posterior leukoencephalopathy, leukoencephalopathy, posterior (Clic here for more details about this article) |
8/17. Posterior reversible leukoencephalopathy in a case of postpartum eclampsia.This case report describes an atypical presentation of eclampsia. A 26-year-old lady presented 5 days' postpartum with a series of grand mal seizures after an uneventful pregnancy and delivery. An MRI scan of the brain showed areas of low signal involving cerebral white matter and right cerebellum. Within 2 weeks, all symptoms and radiologic abnormalities had resolved.- - - - - - - - - - ranking = 35.565413526769keywords = leukoencephalopathy (Clic here for more details about this article) |
9/17. Postpartum eclampsia complicated by reversible cerebral herniation.BACKGROUND: Preeclampsia and eclampsia have been associated with significant morbidity and mortality. Posterior reversible encephalopathy syndrome is a neuroradiologic entity that has been previously reported to occur in patients with preeclampsia and eclampsia. We present, to our knowledge, the first reported case of late postpartum eclampsia complicated by posterior reversible encephalopathy syndrome and reversible cerebral herniation. CASE: A 39-year-old woman (para 1) presented with late postpartum preeclampsia on postpartum day 4. She developed eclampsia and posterior reversible encephalopathy syndrome, which was diagnosed by magnetic resonance imaging. She subsequently developed clinical and radiologic evidence of reversible cerebral herniation. CONCLUSION: Postpartum preeclampsia and eclampsia that is complicated by posterior reversible encephalopathy syndrome can result in cerebral herniation. Neuroradiologic imaging may be a useful adjunctive diagnostic tool in the setting of preeclampsia and eclampsia to predict disease severity.- - - - - - - - - - ranking = 1.5keywords = posterior (Clic here for more details about this article) |
10/17. PRES: posterior or potentially reversible encephalopathy syndrome?Posterior reversible encephalopathy syndrome (PRES) is an acronym that identifies a new clinico-neuroradiologic entity occurring in association with different conditions. We report a patient with eclamptic encephalopathy whose clinico-radiological picture normalised after prompt treatment. We suggest defining this condition as potentially RES, to emphasise that reversibility is not spontaneous but is usually related to an adequate treatment, and that the posterior localisation of the lesions, even if constant, may not represent the most relevant finding in some patients.- - - - - - - - - - ranking = 2.5keywords = posterior (Clic here for more details about this article) |
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