161/165. Eclamptic encephalopathy: imaging and pathogenetic considerations. Eclampsia is a rare condition peculiar to pregnant and puerperal women, characterized by clinical pre-eclampsia (hypertension, proteinuria, edema) and generalized seizures. Three cases of eclamptic encephalopathy are reported: CT and MRI demonstrated transient abnormalities in the cortical and subcortical regions of the posterior areas of the brain - namely, parieto-occipital lobes - associated with occasional involvement of basal ganglia and/or brainstem. Pathogenesis is still unclear. Strict similarity with the pathological findings characterizing hypertensive encephalopathy suggests that a focal impairment in cerebral autoregulation may be the cause of vasodilation and fluid extravasation leading to hydrostatic edema; selective involvement of posterior areas could be explained by their lesser degree of adrenergic innervation supporting circulatory autoregulation mechanisms. ( info) |
| BACKGROUND: To clarify the cerebral hemodynamics in pre-eclamptic pregnant women, we investigated the blood flow velocity of the cerebral arteries. methods: The mean blood flow velocity and pulsatility index (PI) of the middle cerebral artery (MCA) and internal carotid artery (ICA) in normal pregnant women (n = 35) and pre-eclamptic patients (n = 18) were examined transcranially using pulsed-wave Doppler technique with a 2 MHz probe. In two pre-eclamptic women with post-partum visual disturbance, we examined the mean blood flow velocity and PI of the MCA and ICA every day. RESULTS: The mean blood flow velocity of the MCA in the pre-eclamptic patients (89.7 /- 20.5 cm/s) was significantly higher than that in the normal pregnant women (53.6 /- 16.9 cm/s) (p < 0.05). PI of the MCA in the former group (0.67 /- 0.13) was significantly lower than that in the latter (0.78 /- 0.02) (p < 0.05). There was no significant difference between these two groups in these variables of the ICA. In the two patients with visual disturbance, the mean blood flow velocity of the MCA was increased before the onset of visual disturbance and decreased gradually following the disappearance of this symptom. In these patients, spasm of the MCA was confirmed by magnetic resonance angiography. CONCLUSIONS: In pre-eclamptic patients, we found increased MCA mean velocity before the onset of visual disturbance. Transcranial Doppler may be useful for the evaluation of cerebral hemodynamics and the prediction of eclampsia. ( info) |
163/165. Early development of hellp syndrome associated with eclampsia: a case report. The syndrome of haemolysis, elevated liver enzymes and low platelet count during pregnancy (hellp syndrome) is recognized as a serious, multisystem disease and diagnosed generally after thirtieth week of pregnancy. In this report, a case who developed eclampsia with hellp syndrome was discussed. ( info) |
164/165. Neonatal flumazenil therapy reverses maternal diazepam. A woman at 32 weeks' gestation with eclampsia was given 120 mg diazepam shortly before emergency caesarean section. The infant had persistent apnoea and required respiratory support. Spontaneous respiration began after intravenous flumazenil infusion was started. diazepam and its active metabolites were assayed during and after 5 d of treatment with flumazenil. ( info) |
165/165. Eclampsia complicating hydatidiform molar pregnancy with a coexisting, viable fetus. A case report. BACKGROUND: Eclampsia is a rare and serious complication of pregnancy. The occurrence of preeclampsia prior to the 20th week of gestation has been associated with concurrent hydatidiform molar pregnancy. We present a case of eclampsia complicating a partial molar pregnancy associated with a viable fetus. CASE: A 22-year-old white woman, gravida 1, para 0, at 14 weeks' gestation, presented with an excruciating headache associated with hypertension, proteinuria and a viable intrauterine fetus with gastroschisis. Subsequently the patient had a generalized tonic-clonic seizure which resolved with magnesium sulfate therapy. Markedly elevated quantitative human chorionic gonadotropin and a moderately thickened placenta were the sole clinical features suggestive of a molar gestation. Dilation and evacuation was performed revealing unremarkable products of conception. Pathologic and cytogenetic analyses revealed a triploid fetus (69,XXX) consistent with partial molar pregnancy. CONCLUSION: Development of preeclampsia/eclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy. ( info) |