Cases reported "Puerperal Disorders"

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1/25. Spontaneous coronary artery dissection. Case report and literature review.

    Primary coronary artery dissection occurring 2 months post partum in a 33-year-old woman is described. Owing to suspected acute myocardial infarction, the patient was treated with thrombolytic therapy but her condition deteriorated. coronary angiography showed dissection of the left anterior descending artery (LAD). Her condition stabilized during treatment with intravenous heparin, aspirin, nitrates, beta-blockers, digoxin, ACE inhibitor and anticoagulants. At discharge she had no symptoms of heart failure. One hundred and forty one cases from the literature are reviewed with special reference to patient characteristics, patient treatment, and prognosis. Primary spontaneous coronary artery dissection is a rare condition but one that must be considered when young people, especially post partum women, present an acute ischaemic syndrome. thrombolytic therapy may be a two-edged sword and therefore early angiography should be considered in making the diagnosis and choosing the therapy.
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2/25. Periarteritis nodosa presenting as a breast lesion: report of a case and review of the literature.

    We describe a 34-year-old woman with periarteritis nodosa (PAN) presenting as a breast lesion. Localized involvement of the breast is an unusual manifestation of PAN. To date, 10 cases have been reported: all were in women with an age range of 45-78 years (mean 63). In most cases, breast lesions were an isolated finding, and the prognosis was favourable, setting them apart from the more common form of systemic PAN. The case presented is unusual in that vasculitis developed in the postpartum period, and was associated with cutaneous PAN-like lesions elsewhere on the body, and digital artery occlusion. The most important differential diagnoses of PAN of the breast are infectious mastitis, mammary malignancy and other forms of idiopathic vasculitides of the breast, e.g. giant cell arteritis and wegener granulomatosis.
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3/25. Persistent paraneoplastic neurologic syndrome after successful therapy of Hodgkin's disease.

    Paraneoplastic neurologic syndromes may develop in Hodgkin's disease (HD). We describe three young female patients with neurological disorders, not explained by other causes, preceding diagnosis or relapse of HD. The lack of response of the paraneoplastic syndrome to successful treatment of HD among our three patients emphasizes the poor prognosis of longstanding paraneoplastic neurologic symptoms in HD.
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4/25. Peripartum cardiomyopathy: a case series.

    OBJECTIVES: We describe our experience with peripartum cardiomyopathy. DESIGN AND SETTING: A case series in intensive care units (ICU) of a district hospital and a referral center. patients: Six patients who required admission to an ICU after the onset of peripartum cardiomyopathy. RESULTS: Five of the six patients survived, with total recovery of ventricular function. After 1 year of follow-up all five survivors were symptom free with a normal ventricular function. CONCLUSIONS: There is a low rate of ICU admissions for peripartum cardiomyopathy, which has a potentially fatal prognosis. However, this disease can be detected by echocardiography among patients without the semiology.
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5/25. Peripartum cardiomyopathy: echocardiogram to predict prognosis.

    Peripartum cardiomyopathy is an uncommon complication of human pregnancy that threatens both the mother and fetus with maternal congestive heart failure. Clinicians must be aware of this problem in order to provide prompt diagnosis and effective treatment that will insure a favorable return of normal left ventricular function.
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6/25. Postpartum blindness: two cases.

    We present 2 cases, one eclamptic patient and one noneclamptic patient, of headache, cortical blindness, and seizures. Both patients demonstrated findings consistent with posterior leukoencephalopathy syndrome. posterior leukoencephalopathy syndrome is a rapidly evolving neurologic condition that is characterized by headache, nausea and vomiting, seizures, visual disturbances, altered sensorium, and occasionally focal neurologic deficits. posterior leukoencephalopathy syndrome can be triggered by numerous conditions, including preeclampsia-eclampsia, and can be seen in the postpartum period. It is characterized predominately by white matter vasogenic edema of the occipital and posterior parietal lobes. This condition can be difficult to differentiate clinically from cerebral ischemia, and magnetic resonance imaging with diffusion-weighted imaging and apparent diffusion coefficient are needed to do so. In most cases of posterior leukoencephalopathy syndrome, the prognosis is excellent, with full resolution of symptoms.
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7/25. Intracerebral thrombosis. Case report and brief clinical review.

    A 29-yr-old writer presented with seizures and left hemiparesis 8 days post-partum. Studies revealed right parietal hemorrhagic infarction secondary to superior sagittal sinus thrombosis. An anticoagulant was given for clot extension associated with increasing cerebral edema and coma. Inpatient rehabilitation was undertaken for residual left hemiparesis, most severe in the leg. Left arm strength rapidly returned to normal. Significant improvement in left leg strength occurred but was delayed for many months. Intracerebral thrombosis is an uncommon but significant cause of stroke in young adults. It frequently occurs in the puerperium and may be associated with unilateral or bilateral neurologic deficits. Treatment with anticoagulants is controversial because of the risk of hemorrhagic cerebral infarction, but may be beneficial in some cases. Recovery may be delayed for several months pending recanalization of the sinus or the development of collateral circulation. The overall prognosis for neurologic and functional recovery in survivors of intracerebral thrombosis is good.
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8/25. 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.
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9/25. Peripartum cardiomyopathy: a case report.

    Peripartum cardiomyopathy (PPCM) is a relatively rare form of acute heart failure. Onset is from the last trimester of pregnancy to 5 months postpartum. diagnosis is made by excluding other causes of acute heart failure, such as infections or toxins, and by determining that the patient does not have an underlying cardiac problem that has been unmasked by pregnancy. diagnosis in the last trimester is complicated by the fact that the early symptoms of this disorder may mimic the symptoms of normal pregnancy. PPCM must be considered in any patient who presents with new onset peripheral edema, dyspnea on exertion, or paroxysmal nocturnal dyspnea during late pregnancy or up to 5 months postpartum. Limited studies suggest that early and aggressive therapy is associated with a better outcome. Therapy is directed toward decreasing preload and improving cardiac function. Return of cardiac size to normal is associated with a better prognosis than continued cardiomegaly.
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10/25. Call-Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome.

    BACKGROUND: The postpartum angiopathy (Call-Fleming syndrome) is a rare, reversible cerebral vasoconstriction syndrome. Unlike in eclampsia, neither proteinuria nor hypertension have been observed in the Call-Fleming syndrome. CASE: A 17-year-old woman developed headache, seizures, confusion, cortical blindness, and denial of visual loss (optic anosognosia, Anton syndrome) on the first postpartum day. Transcranial Doppler demonstrated severely elevated blood velocities. magnetic resonance angiography showed multifocal segmental narrowing of cerebral arteries. magnetic resonance imaging revealed occipitotemporal edema. After symptomatic treatment, the clinical deficits disappeared completely within 2 weeks. The follow-up neuroimaging performed after 3 months was unremarkable. CONCLUSION: The case shows that the Call-Fleming syndrome is a reversible condition with excellent prognosis representing an important differential diagnosis of eclampsia, dural sinus thrombosis, and intracranial bleeding in puerperium.
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