1/7. 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 = physician (Clic here for more details about this article) |
2/7. 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 = 1keywords = physician (Clic here for more details about this article) |
3/7. Pancreatic necrosis associated with preeclampsia-eclampsia.CONTEXT: Acute pancreatitis during pregnancy is rare and commonly occurs in association with biliary disease. Preeclampsia is associated with microvascular abnormalities that may involve cerebral, placental, hepatic, renal and splanchnic circulation and rarely can cause acute pancreatitis. CASE REPORT: A case of acute pancreatitis in a patient with preeclampsia-eclampsia where the diagnosis was missed initially that resulted in a protracted course and development of organized pancreatic necrosis. The pancreatic necrosis resolved with conservative management over 8 weeks. CONCLUSIONS: The development of severe hypoalbuminemia, out of proportion to proteinuria, hypocalcemia and findings of capillary leak should alert the physician to search for other inflammatory causes, including acute pancreatitis so that early and effective management be given to avoid complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Late postpartum eclampsia as an obstetric complication seen in the ED.Preeclampsia is a complication of pregnancy associated with hypertension and proteinuria. Preeclampsia may be associated with grand mal seizures and is termed eclampsia. Historically, eclampsia occurring more than 48 hours after delivery, known as late postpartum eclampsia, was thought to be uncommon; however, recent evidence suggests that its incidence is increasing. In addition, the presentation of late postpartum preeclampsia-eclampsia may differ from that occurring during the pregnancy. This contributes to difficulty in diagnosing late postpartum preeclampsia-eclampsia in an emergency department setting. We report 2 cases of late postpartum eclampsia presenting 8 days after delivery, which highlight the unique features of this disorder and discuss some of the difficulties in managing these patients. Greater awareness and knowledge of this disorder by ED physicians should improve outcomes in these potentially life-threatening cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Posterior reversible encephalopathy syndrome: a case study.A young woman 4 days postpartum was admitted after experiencing two seizures. Her mentation waxed and waned until, after several hours, staff were unable to arouse her with voice or touch. A computed tomography scan demonstrated considerable white-matter edema. The patient's condition declined to a coma. She remained comatose despite therapeutic interventions to control increased intracranial pressure. To her family, her condition was a source of anguish. To the physicians and nurses, she was a puzzle. The final diagnosis was posterior reversible encephalopathy syndrome, which was related to a preeclamptic condition and its associated hypertension. The collaboration of obstetricians and neurologists with vigilant care by neuroscience nurses resulted in a positive outcome for this challenging patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. cerebrovascular disorders associated with pregnancy.stroke is a leading cause of maternal death. Intracerebral hemorrhage may be associated with eclampsia, metastatic choriocarcinoma or ruptured arteriovenous malformations. Intracranial venous thrombosis may result from a hypercoagulable state or local intracranial vascular damage. subarachnoid hemorrhage is usually caused by the rupture of an intracranial aneurysm or arteriovenous malformation. signs and symptoms of stroke in pregnancy can be confusing. The physician must be aware of these signs to avoid mismanagement of the pregnant stroke patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Unusual manifestations of peripartal cardiac disease.Because peripartal cardiac disease occurs infrequently, its manifestations may be unfamiliar to most physicians. We report two unusual cases of postpartum cardiac disease: one patient presented with cerebral and peripheral arterial embolization, and the second patient developed late eclamptic seizures with subsequent myocardial infarction. Both patients recovered. Nonobstetric physicians should be aware of these pregnancy-associated medical complications to allow prompt diagnosis and aggressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |