1/60. 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 = edema, cerebral, cytotoxic (Clic here for more details about this article) |
2/60. Regional cerebral blood flow after status epilepticus.Two patients with status epilepticus due to specific conditions were examined using MRI and stable Xe/CT CBF. [Case 1] A 30-year-old woman developed a grand mal seizure during delivery. She was comatose, and MRI revealed abnormal high intensity areas bilateral basal ganglia, compatible with eclampsia. Regional CBF was decreased in bilateral occipital lobes and right basal ganglia. Six days after onset. Regional gray matter flow was increased, especially in the thalami and basal ganglia. [Case 2] The patient is a 31-year-old male diagnosed with temporal lobe epilepsy since 10 years. At the onset, he had a prolonged right hemiconvulsion followed by generalized tonic-clonic convulsion. MRI 13 days after onset showed left hemispheric edematous swelling of gray matter. Stable Xe/CT 3 weeks after onset demonstrated increased cortical CBF corresponding to edematous area. The results suggested that regional CBF decreased immediately after status epilepticus and then increased for 1-3 weeks in the interictal period. We speculate that the energy debt incurred during prolonged seizure causes relative ischemic condition in the neurons, with the increase in CBF resulting from accelerated energy production for a long period.- - - - - - - - - - ranking = 1.4477793474475keywords = edema, cerebral (Clic here for more details about this article) |
3/60. neurocysticercosis in pregnancy: a case initially diagnosed as eclampsia.BACKGROUND: neurocysticercosis is an infection of the central nervous system with the pork tapeworm's cysticercus. CASE: A 21-year-old Hispanic primigravida presented at 33 weeks' gestation with acute onset of mental status changes preceded by headaches and emesis. She was transferred comatose to our institution with a diagnosis of postictal state secondary to eclampsia. Upon arrival, the patient developed anisocoria, papilledema, posturing, and hypertension. neuroimaging showed an intraventricular cyst. The patient was treated with ventriculostomy, induction of labor, postdelivery shunting, albendazole, and prednisone. CONCLUSION: neurocysticercosis should be considered in the differential diagnosis of pregnant patients with coma and/or seizures, especially if the patient has emigrated from or traveled to an endemic area. albendazole, with shunt procedure, is the treatment of choice for intraventricular neurocysticercosis.- - - - - - - - - - ranking = 0.25226057802609keywords = edema (Clic here for more details about this article) |
4/60. diffusion-weighted images and vasogenic edema in eclampsia.BACKGROUND: In eclampsia, it is mandatory to recognize specific cerebrovascular complications before initiation of treatment. diffusion-weighted magnetic resonance imaging (MRI) is a new technique that differentiates between cerebral infarction and hypertensive encephalopathy with vasogenic edema. CASE: A 23-year-old primigravida developed eclampsia at 29 weeks' gestation. Focal neurologic signs and neuroimaging findings by computed tomography and MRI were consistent with acute infarction or vasogenic edema. diffusion-weighted MRI did not show an abnormal signal, indicating vasogenic edema. Control of the severe hypertension without anticoagulation therapy was begun. After delivery, the woman's neurologic abnormalities disappeared. CONCLUSION: diffusion-weighted MRI differentiated between cerebral infarction and vasogenic edema, helping in the management of eclampsia.- - - - - - - - - - ranking = 209.07104261123keywords = vasogenic, edema, cerebral (Clic here for more details about this article) |
5/60. Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients.In two patients eclampsia started 9 days postpartum. headache and visual disturbances preceded seizures but none of the classic pre-eclamptic signs oedema, proteinuria, and hypertension were present until shortly before seizure onset. brain herniation (patient 1) and status epilepticus (patient 2) necessitated neurointensive care management. brain MRI initially showed only frontal sulcal effacement in one patient but later showed white matter hyperintensities on T2 weighted images and a previously undescribed pattern of cortical-subcortical postgadolinium enhancement on T1 weighted images in both. Neurological deficits and MRI findings were reversed with therapy in both patients. It is concluded that late postpartum eclampsia can manifest without classic prodromi and that characteristic MRI findings may lag behind clinical manifestation.- - - - - - - - - - ranking = 0.25226057802609keywords = edema (Clic here for more details about this article) |
6/60. 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 = 156.92118923235keywords = vasogenic, edema, cerebral (Clic here for more details about this article) |
7/60. Characteristic magnetic resonance imaging for neurological assessment in hellp syndrome with eclampsia: a case report.hellp syndrome is a complication of pregnancy characterized by hemolytic anemia, elevated liver enzymes, and low platelets. We describe a patient who suffered a generalized tonic seizure as a clinical onset. magnetic resonance imaging (MRI) of the brain showed high intensity lesions on T2-weighted images and low- and iso- intensity on T1-weighed images. The patient fully recovered and on follow-up MRI the abnormal lesions were almost totally resolved. The sensitivity and specificity of MRI is useful in distinguishing this complication of pregnancy from cerebral apoplexy, brain tumor, epilepsy and other causes.- - - - - - - - - - ranking = 0.23581454784882keywords = cerebral (Clic here for more details about this article) |
8/60. Atypical eclampsia: a case report and review.Up to one-third of cases of eclampsia occur in the postpartum period. Often there is evidence of preeclampsia, which alerts the physician to be prepared for the possibility of seizures. eclampsia is an obstetrical emergency often requiring intensive care and monitoring. This reports the case of a 33-year-old gravida 5 para 4 abortus 1 who presented ten days postpartum with eclampsia. The patient had no history of hypertension, edema, or proteinuria during her prenatal visits or hospitalization, and has no history of preeclampsia or eclampsia in previous pregnancies. This case illustrates the rare occurrence of eclampsia late in the postpartum period and the equally rare onset of eclampsia without prior evidence of preeclampsia during her pregnancy. It is followed by a brief review of the relevant literature.- - - - - - - - - - ranking = 0.25226057802609keywords = edema (Clic here for more details about this article) |
9/60. diffusion-weighted imaging shows cytotoxic and vasogenic edema in eclampsia.In eclampsia, MR imaging shows reversible T2 hyperintensities in a parietal and occipital distribution. Findings on diffusion-weighted images suggest that these abnormalities are areas of vasogenic edema. We describe the presence of both cytotoxic and vasogenic edema, as detected by diffusion-weighted imaging, in a woman with eclampsia. Follow-up MR imaging showed that the regions of cytotoxic edema progressed to cerebral infarction. This case suggests that diffusion-weighted imaging allows the early detection of ischemic infarcts in patients with eclampsia.- - - - - - - - - - ranking = 157.05852259781keywords = vasogenic, edema, cerebral, cytotoxic (Clic here for more details about this article) |
10/60. 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 = 1.4148872870929keywords = cerebral (Clic here for more details about this article) |
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