Late Postpartum Eclampsia Research Articles

Posterior Reversible Encephalopathy Syndrome presenting in late postpartum eclampsia challenging differential diagnosis

Posterior Reversible Encephalopathy Syndrome presenting in late postpartum eclampsia challenging differential diagnosis

Posterior reversible encephalopathy syndrome in a patient with late postpartum eclampsia.

Posterior reversible encephalopathy syndrome (PRES) is a rare complication commonly associated with headache and acute changes in blood pressure that results from a variety of causes, culminating in vasogenic cerebral edema in the occipital and parietal lobes of the brain. We report here a woman who suffered from headache, generalized tonic-clonic seizures, and cortical blindness in the late postpartum period. Posterior reversible encephalopathy syndrome. The patient was treated with amlodipine besylate tablets for hypertension, dehydration with mannitol and glycerin fructose, and antispasmodic treatment with sodium valproate and oxcarbazepine. On day 2, the patient became conscious, headache and vision improved. One week later, symptoms and signs disappeared, blood pressure returned to normal, and brain MRI lesions disappeared in re-examination. Eclampsia associated with PRES is reversible in most cases, but it is a serious and potentially life-threatening obstetric emergency. If adequate treatment is provided in a timely manner, most women will make a full recovery. Attention needs to be paid to timely and adequate treatment, as well as appropriate follow-up and support for patients with PRES.

A rare cause of late postpartum convulsion: Cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) is a severe and rare pregnancy complication. The most common symptom is a headache. However, it is less common for headaches to be accompanied by seizures. Postpartum eclampsia (PPE) traditionally refers to convulsions within seven days, but convulsions can occur up to 4 weeks after birth. In this case report, we present our patient who developed cerebral venous sinus thrombosis, which is a very rare complication of the postpartum period and can be confused with late postpartum eclampsia.

An unusual presentation of posterior reversible encephalopathy syndrome\u2014a case report

BackgroundAcute neurological emergencies in pregnant and postpartum women presenting as headache, visual disturbances, seizures, and elevated blood pressure are usually attributed to preeclampsia and eclampsia. However cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two important, rare conditions which should be considered. PRES is a rare neuroradiological syndrome characterised by vasogenic oedema of subcortical white matter, commonly involving posterior cerebral hemispheres. Preeclampsia and eclampsia are the common causes of PRES. However, late postpartum eclampsia concurrent to PRES is rare. Here, we report a rare case of PRES secondary to late postpartum eclampsia with atypical radiological findings.Case presentationA 25-year-old married woman with prior history of two spontaneous abortions presented to us on day 5 postpartum, post lower segment caesarean section (LSCS) with complaints of headache followed by one episode of new onset generalised tonic-clonic seizures. There was no history of seizures prior to the pregnancy and no history of hypertension or diabetes during any of her pregnancies. On examination, BP was 140/90 mm Hg and PR 98 bpm. Systemic examination revealed GCS 15/15, no focal neurological deficits, and bilateral flexor plantar response. Fundus examination was normal with no evidence of hypertensive retinopathy. Preliminary haematological and biochemical tests including antiphospholipid antibody (APLA) profile were done in view of prior abortions and were within normal limits. Lumbar puncture was done—normal study. EEG was normal. MRI with MRV was suggestive of atypical posterior encephalopathy. In view of late onset postpartum seizure, the patient was started on injection of magnesium sulphate, anti-hypertensives, and antiepileptics; following which, she improved and was discharged.ConclusionThough preeclampsia and eclampsia are usually screened entities, we should also follow women in puerperium for late postpartum eclampsia which is defined as seizures beyond 48 h of delivery up to 4 weeks postpartum. So it is important to follow-up postpartum women for complications like PRES because early detection and treatment can lessen the morbidity and mortality as they are completely reversible. Thus, health care professionals should be educated about the same. Apart from antenatal and intrapartum care, postpartum care should also be given equal importance.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in Late Onset Postpartum Eclampsia- A Retrospective Study

Background: Reversible posterior leukoencephalopathy syndrome (RPLS) or Posterior reversible encephalopathy syndrome (PRES) is a unique clinicoradiologic entity characterized by acute onset headache, seizures, blindness and altered mental state associated with reversible vasogenic edema of the brain. It is a major complication of eclampsia, but data on clinicoradiological features of PRES in late-onset postpartum eclampsia are scarce. The objective is to analyze the clinicoradiologic features and outcome in a cohort of late postpartum eclampsia patients with PRES. Subjects and Methods: Eighteen patients of late postpartum eclampsia with clinical as well as neuroimaging features consistent with PRES were included in this retrospective study. All had undergone magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) and apparent diffusion coefficient(ADC) mapping. Data on age, antepartum history, peak systolic and diastolic blood pressures, clinical features, time to neuroimaging, location of lesions on brain imaging and presence of associated ischemia or hemorrhage in MRI were collected and analyzed. Results: The mean age was 25.72 3.23 years. The average duration between labor and clinical symptoms was 8.5 days. 13/18 patients (72.2%) had elevated blood pressure at admission. Mean systolic and diastolic blood pressures were 143.88 (120-180) and 93.88 (80-100) mm Hg respectively. Headache was the presenting feature in 16 patients. The parieto-occipital regions were the most frequently involved followed by the cerebellum (7/18) and frontal lobe (4/18). Atypical regions were not involved. Clinical recovery had been noted in all. Conclusion: PRES associated with late postpartum eclampsia, an entity of limited awareness can present without antecedent preeclampsia. Radiological changes are the key to early diagnosis.

Late postpartum eclampsia

In view of the rarity of late postpartum eclampsia, the author considers it not uninteresting to report a case where he had to observe seizures of eclampsia on the eighth day after childbirth.

Late onset postpartum eclampsia complicated with posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a rare entity characterized by headache, vomiting, visual disturbances, seizure and unconsciousness with characteristic magnetic resonance imaging. Late onset postpartum eclampsia complicated by PRES has been reported in the literature, 
 We report a unique case of 23-year-old patient who developed late onset postpartum eclampsia complicated by PRES and acute kidney injury requiring renal replacement therapy. The case report emphasizes the need to continue antihypertensive medication in hypertensive parturients during postpartum period for at least 6 weeks as frequency of late postpartum eclampsia is high. The medication should be tapered off slowly to avoid reactive hypertensive episode which might trigger PRES and acute kidney injury.

Posterior reversible encephalopathy syndrome after massive transfusion in a patient with postpartum vaginal hematoma

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome characterized by headache, potentially reversible neurological deficits. PRES has been described in various clinical settings, such as severe hypertension, eclampsia, and chemotherapy. Transfusion related PRES are rare. We report a patient with postpartum vaginal hematoma who manifested PRES after massive packed red blood cell transfusion confirmed by brain MRI and clinical features. A 34-year-old woman gravida 1, para 1 admitted for surgery of postpartum vaginal hematoma, rectum repair, sphincter repair. Twelve hours ago, she was delivered. After delivery her uterine contraction was poor and vaginal bleeding was persistent. On admission, her hematocrit was at 27.2%, and her hemoglobin was at 9.0 g/dl. She received 18 packed red blood cell transfusion and 10 packed fresh frozen plasma. Her hematocrit and hemoglobin increased 41.1% and 13.9 g/dl, and platelet increased up to 78,000/ul. After 2 days of the transfusion, she had a left eye ball deviation and 5 min prolonged confusion. Her blood pressure was normal, and no other contributing factors for PRES were found. Brain MRI showed regional T2 signal change in right occipital lobe including cortex, and small signal change in left occipital lobe. In this case, some relation may have existed between late postpartum eclampsia and PRES, but the pathogenesis remains unclear. Although blood transfusion is a common procedure with rare neurological complications, great caution should be taken with anemic patients because a rapid elevation in hemoglobin may precipitate PRES.

Posterior Reversible Encephalopathy Syndrome in Late Postpartum Eclampsia: A Case Report

Late postpartum eclampsia is defined as the onset of a seizure more than 48 hours after delivery. Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by clinical manifestations such as seizures, headaches, visual disturbances, altered mental status, and characteristic magnetic resonance imaging findings, including sub-cortical vasogenic edema at the bilateral parietal and occipital lobes. Late postpartum eclampsia concurrent with PRES is rare, and not always preceded by preeclampsia before delivery. We report the case of a 26-year-old woman who developed PRES with late postpartum eclampsia 5 days after cesarean delivery but did not have hypertensive disease during pregnancy.

Reversible posterior encephalopathy syndrome associated with late onset postpartum eclampsia

Posterior reversible encephalopathy syndrome (PRES) is a clinic neuro radiological entity presenting with headache, confusion, visual disturbances or blindness, and seizures. Parieto-occipital white matter changes due to vasogenic oedema can be observed on imaging modalities. We report a 22-years-old prime gravida with twin delivery with a history of Late onset eclampsia post-delivery, complicated by PRES. Late onset postpartum eclampsia (LPE) is defined by its onset at >48 h after delivery. In our case convulsions and hypertension happened post-delivery with a diagnosis of LPE which have been complicated by PRES. Clinical improvement with complete resolution without any complications was observed on the 6th day after delivery with proper treatment of hypertension and Convulsions. Early diagnosis was a big asset, using clinical and radiological skills.Posterior reversible encephalopathy syndrome is reversible when early diagnosis is established and appropriate treatment is started without delay.

Posterior reversible encephalopathy syndrome – unusual manifestation of late postpartum eclampsia

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome associated with headache, convulsions, visual disturbance and encephalopathy. Cerebral imaging of the condition is dominated by parieto-occipital white matter changes. We report a case of a 33-year-old multiparous woman with late postpartum seizures preceded by severe headache and visual disturbances. She was initially diagnosed with post-spinal headache but developed seizures. She was then diagnosed as having eclamptic fits and magnetic resonance venography revealed lesions suggestive of PRES. With prompt management the patient improved. This emphasizes the importance of early diagnosis of postpartum eclampsia to allow prompt management and prevent neurological sequelae.

Reversible posterior encephalopathy syndrome associated with late onset postpartum eclampsia: A case report.

Late onset postpartum eclampsia (LPE) is defined by its onset at >48 h after delivery. Reversible posterior encephalopathy syndrome (RPES) associated with LPE is uncommon, with the majority of RPES cases having a late postpartum onset within 4 weeks after childbirth. The present study reported the case of a 15-year old female presenting with convulsions that began 5 weeks after delivery. A magnetic resonance imaging scan of the brain revealed multiple lesions in the cortex, subcortical region and deep white matter of the bilateral cerebellum, and occipital, frontal and parietal lobes. The clinical manifestations and radiological abnormalities were readily resolved subsequent to antihypertension and anticonvulsion treatment. In conclusion, the present rare case indicates that LPE should be considered as a potential diagnosis even at 4 weeks after delivery. Furthermore, clinicians should familiarize with the reversible radioimaging features of RPES, since early recognition and adequate treatment are important to the outcome of patients.

Management of seizure on Postpartum Day 8: A case report of late postpartum eclampsia

Management of seizure on Postpartum Day 8: A case report of late postpartum eclampsia

Preeclampsia prevention

Colombia and Brazil are developing countries where pregnancy-related hypertensive disorders and associated conditions constitute major concerns in public health area. Calcium plus conjugated linoleic acid used by pregnant adolescents had preventive effect on PE, but the prevention did not occur with utilization of calcium alone. After implementation of Colombian prenatal care program based on the bio-psychosocial model, maternal mortality and the rate of PE reduced in 23% and 22%, respectively. Late postpartum eclampsia, is the onset of seizuress more than 48 hours, but less than four weeks after delivery. This severe condition may occur without antecedent of PE. Lower maternal mortality due to preeclampsia/ eclampsia can follow implementation of prenatal programs based on BPSM, and use of calcium plus conjugated linoleic acid

Late postpartum eclampsia complicated with posterior reversible encephalopathy syndrome: a case report and a literature review.

Posterior reversible encephalopathy syndrome (PRES) is a rare but serious clinical-neuroradiological entity characterized by headache, vomiting, visual disturbances, altered mental status, seizures, and unconsciousness associated with the characteristic imaging findings including sub-cortical vasogenic edema at the bilateral parietal and occipital lobes. We describe a case of 28-year-old PRES patient secondary to delayed maternal postpartum eclampsia. This patient was not initially diagnosed with pre-eclampsia and PRES. The diagnosis was established after magnetic resonance imaging. After treatment this patient's PRES resolved. Early diagnosis and treatment are the keys to reverse PRES. A literature review for PRES is provided in this report.

Late Postpartum Eclampsia with Postpartum Angiopathy: An Uncommon Diagnosis in the Emergency Department

BackgroundLate postpartum eclampsia is defined as occurrence of eclampsia >48 h after delivery and is a rare clinical entity. The delayed onset and nonspecific symptoms at presentation make this entity a challenge to diagnose in patients presenting to the emergency department (ED); however, early recognition and timely interventions are the keys to reducing morbidity and mortality in patients with late postpartum eclampsia. Case ReportA 28-year-old woman presented to our ED with a chief complaint of headache of 4 days duration, 8 days after an uncomplicated, normal vaginal delivery. Her past medical history was unremarkable and her entire pregnancy was without medical incident. The patient's examination was within normal limits other than a blood pressure of 152/111 mm Hg and pulse of 54 beats/min. Given her undifferentiated headache and the possibility of preeclampsia, the patient was treated with magnesium sulfate, which was subsequently stopped due to worsening bradycardia. Hydralazine was administered for blood pressure control. Three hours after the magnesium was stopped, the patient reported blurry vision, which was immediately followed by a generalized tonic-clonic seizure. After the seizure, lorazepam was given for control of seizures, and the patient was admitted to the medical intensive care unit. The patient was transferred to the postpartum floor 6 days later in stable condition and without any further seizure activity. Why Should an Emergency Physician Be Aware of This?Patients with late postpartum eclampsia are infrequently encountered in the ED due to the rarity of this condition. Increased awareness of this entity among emergency physicians will lead to early interventions, which are crucial in decreasing morbidity and mortality in these patients.

237-POS

Objectives Presentation of two cases of late postpartum eclampsia that took place at our hospital, one month apart. Eclampsia is defined as generalized seizures, in the setting of preeclampsia, without other neurologic conditions. With an incidence of 1:2.000 deliveries in developed countries, it occurs in 2% of women with severe preeclampsia and in 0.5% of those with non-severe preeclampsia. Although it may occur from gestation to puerperium, it is estimated that only 5–17% of cases take place after 48 h postpartum. While eclampsia is a clinical diagnosis, most cases present with reversible posterior leukoencephalopathy syndrome (RPLS) findings on MRI. Methods Review of literature and consultation of clinical files. Results CASE 1 – A 28-year-old female, G2P0, underwent cesarean delivery, at 38 weeks’ gestation, in the setting of preeclampsia and abnormal nonstress test. On day 6 postpartum, she experienced sudden frontooccipital headache, after which she had three generalized tonic–clonic seizures. On admission, she was postictal and hypertensive (170/120 mmHg), proteinuria 4+, normal CT scan and EEG. MRI revealed lesions compatible with PRLS. She was admitted to the ICU and treated with magnesium sulfate, valproate and antihypertensive medication, with no further seizures and gradual normalization of blood pressure. CASE 2 – A 31-year-old female, G5P3, with gestational hypertension, underwent vaginal delivery at 40 weeks’ gestation. Since day 2 postpartum she complained of a mild headache. On day 4 she developed blurred vision followed by generalized tonic–clonic seizure. At admission to the ICU, BP was 168/110 mmHg. CT and EEG were normal. MRI revealed RPLS. She underwent therapy with magnesium sulfate, valproate and antihypertensive therapy, with no additional seizures and stabilization of blood pressure. Conclusions Prompt exclusion of other causes of seizures, especially in late presentations, combined with early diagnosis and treatment, are central to avoid morbidity and mortality associated with eclampsia. Disclosures S. Nascimento: None. R. Gomes: None. T. Matos: None. I. Santos: None. F. Matos: None.

English

Eclampsia & severe preeclampsia have neurological manifestations. Serum Lactate dehydrogenase (LDH) levels are more in the group that later develops hypertensive encephalopathy. Posterior reversible leukoencephalopathy syndrome (PRES) is a clinical and radiological entity presented by headache, altered mental state, cortical visual disturbances & seizures with transient edematous changes of subcortical white matter. Neuroimaging is must in late postpartum eclampsia

Cortical visual loss in posterior reversible encephalopathy syndrome in late postpartum eclampsia: case series.

The purpose of this study was to determine the prevalence of visual disturbances in patients with posterior reversible encephalopathy syndrome (PRES) associated with late postpartum eclampsia. We retrospectively reviewed the clinical records of late postpartum eclampsia patients with features of PRES for the presence of visual disturbances and location of radiological abnormalities. We found a higher prevalence of cortical visual loss in patients with PRES associated with late postpartum eclampsia. Bilateral symmetrical vasogenic edema of the parieto-occipital lobe was the most common magnetic resonance imaging (MRI) abnormality noted. No significant differences were observed in the extent of edema in patients with and without visual loss.

Delayed Postpartum Eclampsia

Eclampsia is an important cause of maternal mortality in the developing world. While eclampsia typically occurs before or within two days of delivery, it can still occur between two days and a month after the patient delivers, known as delayed postpartum eclampsia. The presented case is a good example of late postpartum eclampsia, and it highlights the importance of prompt recognition and diagnosis during the postpartum period in order to initiate the appropriate treatment.