Urquiza CF, Hernández-Pacheco JA

Language: Spanish
References: 17
Page: 261-270
PDF size: 466.32 Kb.

ABSTRACT

Background: Seizures during pregnancy are the most frequent neurological complication. Most occur in patients with epilepsy. When the first crisis appears during pregnancy, the cause must be determined.
First case: A 28-year-old patient with a history of high blood pressure. She was in the late puerperium with over-added preeclampsia when she presented three seizures. She went to the emergency room and started magnesium sulfate, evolving to epileptic status. Neuroimaging studies were performed and reported thrombosis of the left frontal cortical vein. Neuroprotection measures were applied with adequate clinical evolution. She was discharge without motor, sensory and cognitive deficits.
Second case: A 22-year-old patient with a history of a chronic progressive external ophthalmoplegia mitochondrial cytopathy. She was in her first pregnancy without prenatal control. At the 28 week she began with headache and had a seizure. She went to the emergency department with high blood pressure, so she was given antihypertensive therapy and magnesium sulfate. Neuroimaging studies reported a posterior reversible encephalopathy syndrome secondary to eclampsia. The pregnancy was interrupted, and she evolved favorably.
Conclusion: Seizures in pregnancy and puerperium in women with hypertensive diseases of pregnancy may have benign behavior or may be life-threatening. We propose a diagnostic algorithm for the approach of these patients, highlighting the clinical suspicion of other causes of seizures as the main indication of imaging studies.

REFERENCES

1. Johnson AC, Cipolla MJ. The cerebral circulation during pregnancy: Adapting to preserve normalcy. Physiology 2015; 30 (2): 139-47. doi: 10.1152/physiol.00048.2014.

2. Zack M, Kobau R. National and state estimates of the numbers of adults and children with active epilepsy United States, 2015. Morb Mortal Wkly Rep 2017; 66 (31): 821- 25. doi: 10.15585/mmwr.mm6631a1.

3. Bollig KJ, Jackson DL. Seizures in pregnancy. Obstet Gynecol Clin N Am 2018; 45 (2): 349-67. doi: 10.1016/j. ogc.2018.02.001.

4. Beach RL, Kaplany PW. Seizures in pregnancy: Diagnosis and management. International Review of Neurobiology 2008 (83): 259-71. doi: 10.1016/S0074-7742(08)00015-9.

5. Cipolla MJ, Kraig RP. Seizures in women with preeclampsia: Mechanisms and managment. Fetal Matern Med Rev 2011; 22 (2): 91-108. doi: 10.1017/S0965539511000040.

6. Junewar V, et al. Neuroimaging features and predictors of outcome in eclamptic encephalopathy: A prospective observational study. Am J Neuroradiol 2014; 35 (9): 1728- 34. doi: 10.3174/ajnr.A3923.

7. Sells CM, Feske SK. Stroke in pregnancy. Semin Neurol 2017; 37 (6): 669-78. doi: 10.1055/s-0037-1608940.

8. Rajiv KR, Radhakrishnan A. Status epilepticus in pregnancy: Etiology, management, and clinical outcomes. Epilepsy Behav 2017 (76): 114-19 doi: 10.1016/j.yebeh.2017.07.002.

9. Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. Am J Neuroradiol 2007; 28 (7): 1320-27. doi: 10.3174/ajnr.A0549.

10. Schwartz RB, et al. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology 2000; 217 (2): 371-76. doi: 10.1148/radiology.217.2.r00nv44371.

11. McKinney AM, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. Am J Roentgenol 2007; 189 (4): 904-12. doi: 10.2214/AJR.07.2024.

12. Bartynski WS. Posterior reversible encephalopathy syndrome. Part I Fundamental imaging and clinical features. Am J Neuroradiol 2008; 29 (6): 1036-42. doi: 10.3174/ ajnr.A0928.

13. Hefzy HM, et al. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. Am J Neuroradiol 2009; 30 (7): 1371-79. doi: 10.3174/ajnr.A1588.

14. Brewer J, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol 2013; 208: 468.e1–6. doi:10.1016/j.ajog.2013.02.015.

15. Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol 2017; 264 (8): 1608-16. doi: 10.1007/s00415-016-8377-8.

16. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol 2019;133(1):e1-e25. doi: 10.1097/AOG.0000000000003018.

17. De la Torre León T, et al. Encefalopatía posterior reversible durante el puerperio, secundaria a eclampsia. Reporte de dos casos. Ginecol Obstet Mex. 2018; 86(12):815-822. doi: 10.24245/gom.v86i12.2343.