Sudden and Unexpected Seizure during Emergency Cesarean Section in a Nonhypertensive Hypothyroid Primigravida

Abstract

A 29-year-old primigravida parturient at term with a known case of hypothyroidism for the past 1 year was taken for emergency cesarean section in view of fetal distress. The patient's medical history showed a history of galactorrhea, for which magnetic resonance imaging of the brain and the routine blood investigations were normal. The parturient was posted for emergency cesarean section due to fetal distress. There was no significant comorbid illness or illicit drug intake. All the basic investigations including the thyroid-stimulating hormone were normal. Spinal anesthesia with 2.0 ml of 0.5% hyperbaric bupivacaine to achieve a level of T6 was performed. After the delivery of the fetus, there was a sudden seizure occurred, and the mother lost her consciousness. The hemodynamics remained stable. The patient was given oxygen, 2 mg of intravenous midazolam, and magnesium sulfate by the Pritchard regimen. The newborn's Apgar scores were normal. She had no recollection of the seizure attack after regaining consciousness and normal spontaneous respiration which occurred in a few minutes. Breastfeeding was recommended. To avoid another seizure episode, the Pritchard regimen was followed. The recovery period was uneventful. A cranial computed tomography scan of the brain was also performed, which revealed no abnormalities. Serum electrolytes were within the normal range when tested again. This case is being reported to raise awareness of seizures in nonhypertensive patients.