1/28. Brain MRI in peripartum seizures: usefulness of combined T2 and diffusion weighted MR imaging.Peripartum seizure is a serious disease with significant morbidity and mortality for women and their unborn children. The underlying etiologies are varied, with eclampsia and venous stroke being the most common causes. T2 weighted MR images of the brain show hyperintense lesions in either condition. diffusion weighted MR images (DWI) of the brain is abnormal in strokes. We report three cases of eclampsia with abnormal T2 weighted images, but normal DWI. diffusion weighted MR images in association with T2 weighted MR images can be extremely helpful in evaluation of women with new onset peripartum seizures.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/28. Anaesthesia for caesarean section in a patient with recent subarachnoid haemorrhage and severe pre-eclampsia.Subarachnoid haemorrhage is a leading 'indirect' cause of maternal death in the UK. We describe the case of a 43-year-old woman who presented with headache, photophobia and neck stiffness of sudden onset at 32 weeks' gestation. Cerebral computed tomography demonstrated subarachnoid blood in the cisterns around the midbrain, and oral nimodipine was started to prevent vasospasm. Preparations were made for endovascular coil embolisation in the event of identification of a posterior circulation aneurysm. However, angiography under general anaesthesia failed to reveal any vascular abnormality. On emergence from anaesthesia, headache persisted, and over the next 24 h severe pre-eclampsia developed. magnesium sulphate was started, and urgent Caesarean section performed under general anaesthesia without incident. The rationale for the neuroradiological, obstetric and anaesthetic management is discussed.- - - - - - - - - - ranking = 1533.1394105688keywords = haemorrhage, brain (Clic here for more details about this article) |
3/28. Anaesthetic management of splenectomy in Evan's syndrome during pregnancy with pregnancy induced hypertension.The management of idiopathic thrombocytopenic purpura (ITP) during pregnancy, especially with ongoing bleeding diathesis, has not been highlighted sufficiently in the literature. Aortocaval compression and reduction in uteroplacental circulation resulting in foetal hypoxia and acidosis, Mendelson's syndrome due to gravid uterus, trauma to airway with resultant haemorrhage and aspiration into lungs, compromised airway due to short neck, anasarca and heavy breast, limitation in using invasive monitoring and regional anaesthesia and uncontrolled bleeding leading to placental hypoperfusion and foetal hypoxia are some of the important risks. In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.- - - - - - - - - - ranking = 306.52788211375keywords = haemorrhage (Clic here for more details about this article) |
4/28. Don't throw in the towel! A case of reversible coma.A young woman with pre-eclampsia became unresponsive shortly after delivery. Examination revealed extensive brain stem dysfunction with absent pupillary light reflexes and decerebrate posturing. Computed tomography showed hypodensity throughout the brain stem, and it was initially thought that she had suffered catastrophic brain stem infarction. However, magnetic resonance diffusion imaging and apparent diffusion coefficient mapping showed that she had brain stem vasogenic oedema (posterior reversible encephalopathy syndrome, PRES), rather than cytotoxic oedema. With antihypertensive and supportive treatment, she recovered rapidly, and had no abnormalities on repeat imaging.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
5/28. Permanent blindness as a complication of pregnancy induced hypertension.BACKGROUND: Visual disturbances are common symptoms of preeclampsia, but blindness remains a rare phenomenon. CASE: A 21-year-old secundagravida was admitted at 3547 weeks' gestation with a diagnosis of preeclampsia. She labored on her second hospital day and underwent a cesarean delivery for nonreassuring fetal status. On postoperative day 1, she reported blurring of her vision that progressed rapidly to complete vision loss. Ophthalmological examination revealed ischemic retinal changes bilaterally; radiographic examination showed lesions in the lateral geniculate bodies, consistent with infarcts, as the possible etiologies of her blindness. Five months later, the patient has not regained her sight and remains legally blind. CONCLUSION: Complete amaurosis is a rare complication of pregnancy demanding immediate ophthalmological and neurological evaluation as well as radiographic studies of the brain.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
6/28. Reversible cortical blindness in preeclampsia.PURPOSE: To report the clinical course and magnetic resonance imaging (MRI) findings in a 28-year-old woman with preeclampsia and reversible cortical blindness. DESIGN: Interventional case report. methods: The patient presented at the 37th week of pregnancy with headache and hypertension. The next day, her visual acuity decreased to light perception in both eyes. After emergent cesarean section, examination revealed reactive pupils and normal fundi. RESULTS: magnetic resonance imaging of the brain showed areas of increased signal in both occipital lobes. One month later, at which time the patient's visual acuity had returned to 20/20, follow-up MRI showed complete resolution of radiologic abnormalities. CONCLUSIONS: Cortical blindness is a rare complication of preeclampsia. In this case, cortical blindness was reversible and most likely due to vasogenic edema rather than vasospasm.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
7/28. Anti-shock garment provides resuscitation and haemostasis for obstetric haemorrhage.OBJECTIVE: To evaluate the feasibility, safety and effectiveness of the non-pneumatic anti-shock garment for resuscitation and haemostasis following obstetric haemorrhage resulting in severe shock. DESIGN: During a six-week period, the author served a locum tenens as the obstetrician consultant for the Memorial Christian Hospital, Sialkot, pakistan. All women who suffered from severe obstetric haemorrhage were managed with the anti-shock garment as the first intervention. The data for this report were collected from hospital chart review. SETTING: Sialkot is a city of about three million and Memorial Christian Hospital is one of two major obstetric hospitals. There is no blood bank at Memorial Christian Hospital or elsewhere in Sialkot. The Memorial Christian Hospital laboratory is able to draw donor blood, type and cross match blood, and process it for transfusion 24 hours per day. population: During the six weeks of this study, in June and July 2001, there were 764 deliveries and 34 other admissions within a week following deliveries outside the hospital. Seven women with obstetric haemorrhage who developed severe shock were managed with the anti-shock garment. One woman, who was later found to have mitral stenosis, developed dyspnea upon placement of the anti-shock garment and therefore it was removed within 5 minutes. This report concerns the six women who were able to tolerate the anti-shock garment without untoward symptoms. methods: As soon as severe shock was recognised in the hospital, the anti-shock garment was placed. Crystalloid solutions were given intravenously over the first hour at a rate of 1500 mL per estimated litre of blood loss, then at a maintenance rate of 150 mL/hour. vital signs every 15 to 30 minutes, hourly urine output and intermittent oxygen saturation were used to monitor patients during the use of the anti-shock garment. When sufficient blood transfusion had been given to restore the haemoglobin to >7 g/dL, the anti-shock garment was removed in segments at 15-minute intervals with documentation of vital signs before removal of each subsequent portion. MAIN OUTCOME MEASURES: Restoration of mean arterial pressure of 70 mmHg and clearing of sensorium were considered as signs of effective resuscitation. Haemorrhage was considered controlled if the blood loss was less than 25 mL/hour. morbidity included any complications noted in the medical chart. RESULTS: Restoration of blood pressure and improvement of mental status occurred within 5 minutes in two patients who were pulseless and three who were unconscious or confused. All patients had improvement of mean arterial pressure to greater than 70 mmHg within 5 minutes. Duration of anti-shock garment use ranged from 12 to 36 hours and none of the six women had significant further bleeding while the anti-shock garment was in place. patients were comfortable during use of the anti-shock garment and no adverse effects were noted apart from a transient decrease in urine output. CONCLUSIONS: The anti-shock garment rapidly restored vital signs in women with severe obstetric shock. There was no further haemorrhage during or after anti-shock garment use and the women experienced no subsequent morbidity. A prospective randomised study of the anti-shock garment for management of obstetric haemorrhage is needed to further document these observations.- - - - - - - - - - ranking = 2758.7509390238keywords = haemorrhage (Clic here for more details about this article) |
8/28. Impaired dynamic cerebral autoregulation in eclampsia.Eclampsia is frequently associated with brain edema, cerebral infarction or hemorrhage. Its underlying cerebrovascular pathophysiology is still poorly understood. We examined cerebral autoregulation by a non-invasive multimodal assessment in a 28-year-old primaparous woman with postpartal eclampsia. Transcranial Doppler sonography showed considerably increased cerebral blood flow velocity (CBFV) of all basal cerebral vessels. magnetic resonance imaging demonstrated multifocal vasogenic brain edema. Using transfer function analysis, a severely decreased phase shift between respiratory-induced 0.1-Hz oscillations of arterial blood pressure and CBFV was observed, indicating substantial disturbance of dynamic cerebral autoregulation (DCA). In contrast, CO(2)-vasomotor reactivity of the right middle cerebral artery was only slightly reduced. We therefore assume that the cerebral arteriolar dysfunction in eclampsia leads primarily to an impairment of the autoregulatory mechanism that is followed by different degrees of arteriolar vasodilation. Because of its probably high sensitivity to hemodynamic disturbances, assessment of DCA might be of great value in early pre-eclampsia for risk prediction of cerebral arteriopathy and eclampsia.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
9/28. A case of reversible postpartum cytotoxic edema in preeclampsia.We report on a 32-year-old woman who developed reversible cortical blindness and right-sided weakness after cesarean section at 36 weeks of gestation, due to preeclampsia. An initial brain MRI demonstrated high signal intensity lesions in the bilateral occipito-parietal and left frontal lobes on T2-weighted and diffusion-weighted imaging. All of the lesions showed low signal intensity on apparent diffusion coefficient (ADC) map, which were compatible with cytotoxic edema, and MR angiography (MRA) showed diffuse vasospasm of the intracranial vessels. A follow-up brain MRI showed that most of the lesions disappeared and the vasospasm also resolved. This case suggests that the cytotoxic edema in preeclampsia may evolve differently from the pattern in cerebral infarction and explains the relatively benign course of the neurological signs in preeclampsia.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
10/28. Brainstem ischemia and preeclampsia.Diffuse neurological manifestations of preeclampsia are due to endothelial involvement that lead to ischemia, hemorrhage, or edema. We analyzed clinical and radiological features and the course of brainstem ischemic strokes in a preeclampsia patient. We report a case of severe preeclampsia in a 30-year-old woman who was admitted 10 hr after a vaginal delivery at home. The pregnancy was at 39 wk, with no prenatal care. At her admission, she was conscious, and she had tetraparesia, swinging deep tendon reflex testing, drowsiness, and dysarthria; the BP was at 160/100 mmHg and 4 proteinuria; magnetic resonance imaging revealed brainstem ischemic stroke. The evolution was favorable with symptomatic treatment. The patient was discharged on the 16th day; 2 months later she had a normal recovery. Brainstem strokes are rare. They are frequently due to hemorrhage; sometimes, they can also be ischemic. Their course is favorable.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
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