Reversible posterior leukoencephalopathy syndrome: a report of 2 cases.
(17/167)
Reversible posterior leukoencephalopathy syndrome (RPLE) is an increasingly recognised disorder, most commonly associated with malignant hypertension, toxaemia of pregnancy or the use of immunosuppressive agents. Two cases of RPLE syndrome occurring in the setting of accelerated hypertension and eclampsia are described. Both patients had seizures, altered sensorium and typical findings on neuroimaging. They had complete clinical and radiological recovery. The clinical course, pathophysiology and neuroimaging features of RPLE syndrome are discussed. (+info)
A genome-wide scan for preeclampsia in the Netherlands.
(18/167)
Preeclampsia, hallmarked by de novo hypertension and proteinuria in pregnancy, has a familial tendency. Recently, a large Icelandic genome-wide scan provided evidence for a maternal susceptibility locus for preeclampsia on chromosome 2p13 which was confirmed by a genome scan from Australia and New Zealand (NZ). The current study reports on a genome-wide scan of Dutch affected sib-pair families. In total 67 Dutch affected sib-pair families, comprising at least two siblings with proteinuric preeclampsia, eclampsia or HELLP-syndrome, were typed for 293 polymorphic markers throughout the genome and linkage analysis was performed. The highest allele sharing lod score of 1.99 was seen on chromosome 12q at 109.5 cM. Two peaks overlapped in the same regions between the Dutch and Icelandic genome-wide scan at chromosome 3p and chromosome 15q. No overlap was seen on 2p. Re-analysis in 38 families without HELLP-syndrome (preeclampsia families) and 34 families with at least one sibling with HELLP syndrome (HELLP families), revealed two peaks with suggestive evidence for linkage in the non-HELLP families on chromosome 10q (lod score 2.38, D10S1432, 93.9 cM) and 22q (lod score 2.41, D22S685, 32.4 cM). The peak on 12q appeared to be associated with HELLP syndrome; it increased to a lod score of 2.1 in the HELLP families and almost disappeared in the preeclampsia families. A nominal peak on chromosome 11 in the preeclampsia families showed overlap with the second highest peak in the Australian/NZ study. Results from our Dutch genome-wide scan indicate that HELLP syndrome might have a different genetic background than preeclampsia. (+info)
Conservative management of eclampsia and severe pre-eclampsia--A Bangladesh experience.
(19/167)
OBJECTIVE: To observe whether the pregnancy can be safely continued for a reasonable period to gain fetal maturity in cases of eclampsia and severe pre-eclampsia. METHODS: Fifty-one patients were followed up in a specialized care (eclampsia) unit in Dhaka Medical College and Hospital between January 1998 and October 2000. Twenty-one patients with complaints of headache and blurred vision, and 30 patients with history of convulsion, all at gestational age < 36 weeks, were enrolled for this study. Magnesium sulfate was used to prevent convulsion in severe pre-eclampsia and to control convulsion in eclampsia. After conducting a baseline assessment, pregnancy was continued to gain fetal maturity. Patients were monitored closely. Diastolic blood pressure, 24-hour urinary total protein (UTP), and serum uric acid were chosen as the main parameters to detect the deterioration of a patient's condition. Pregnancy was terminated when deterioration occurred, as determined clinically or by 1 or more of the above parameters. Dexamethasone was used during the waiting period for fetal lung maturity. Patient outcomes were analyzed. RESULTS: At admission, the patients' mean gestational age ( SD) was 30.65 2.38 weeks, and the range was 24-34 weeks. Mean diastolic blood pressure was 109.06 11.61 mm Hg, 24-hour UTP was 2.25 1.73 g/24 h, and serum uric acid level was 5.5 1.12 mg/dL. Pregnancy was continued for a mean of 13.27 8.26 days (range, 3-35 days). Thirty-two babies (62.75%) with birth weight 1.0-2.5 kg (2.02 0.45) were born alive. Six of them (18.75%) weighing between 1.0 and 1.5 kg at birth were referred to the intensive care unit, and 1 (3.13%) weighing 1 kg at birth died within 5 minutes after birth. Among live-born babies, 93.75% were in good condition at the time of discharge from the hospital. Intrauterine death occurred in 19 (37.25%).cases. Twelve of them delivered spontaneously within 7 days of death and 7 required induction. In all cases, maternal condition was satisfactory. CONCLUSION: In carefully selected cases and with close supervision, pregnancy may be continued in women with eclampsia and severe pre-eclampsia to increase fetal maturity without increasing the risk to the mother. (+info)
The role of magnesium in the emergency department.
(20/167)
Magnesium has been advocated for the treatment of a variety of conditions seen in emergency medicine. The authors present a systematic review and advice on appropriate indications for its use. Evidence supports its use in severe asthma, eclampsia, and torsade de pointes. There is insufficient evidence to justify its routine use in other emergencies. (+info)
The neurology of eclampsia : some observations.
(21/167)
Nineteen patients admitted with diagnosis of eclampsia in a large general hospital between 1996 - 1999, were analyzed. Eight patients were referred to neurologists for assessment and management. All these patients had recurrent generalized seizures. Five patients developed visual disturbance. Neuroimaging (CT and/or MRI) revealed symmetrical occipital lesions in all. One patient had a large pontine lesion. Seizure control was achieved in all with intravenous phenytoin. All patients recovered fully without any residual neurological deficit and their radiological brain lesions resolved completely, in all except one case. The neurological manifestations and neuroimaging features in cases of eclampsia have been reviewed. A brief note on the pathogenesis of the cerebral lesions is included and the controversial aspect of seizure control in eclampsia highlighted. (+info)
Management of hypertensive emergencies of pregnancy by hydralazine bolus injection vs continuous drip--a comparative study.
(22/167)
This prospective study was conducted at Dhaka Medical College and Hospital, Bangladesh. The objective was to identify the time required to control high blood pressure levels in obstetric patients by injection of hydralazine in a bolus intravenous dose vs continuous drip. Seventy-seven patients with eclampsia and hypertensive emergencies comprised the target population. Patients were managed either by hydralazine drip in normal saline (existing official protocol, n = 33) or hydralazine bolus injection (as experiment, n = 44) until diastolic blood pressure fell to 90-95 mmHg. Results were compared. Student's t-test was done for statistical significance, and a P value of <.05 was considered as significant. The groups were similar with respect to maternal age and their mean systolic and diastolic blood pressure at the time of enrollment. Patients who received bolus injection required less time to achieve the therapeutic goal (65.23 +/- 23.38 minutes) than continuous drip (186.36 +/- 79.77 minutes; P <.001). The experimental group also required significantly lower doses (6.68 +/- 1.66 mg) in comparison to that required by control group (20.07 +/- 11.38 mg; P <.001). There was no overshoot hypotension in either group. The data suggest that hydralazine bolus dose is equally safe and more effective than continuous drip in the management of hypertensive emergencies in pregnancy. (+info)
A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia.
(23/167)
OBJECTIVE: Magnesium sulfate may prevent eclampsia by reducing cerebral vasoconstriction and ischemia. Nimodipine is a calcium-channel blocker with specific cerebral vasodilator activity. Our objective was to determine whether nimodipine is more effective than magnesium sulfate for seizure prophylaxis in women with severe preeclampsia. METHODS: We conducted an unblinded, multicenter trial in which 1650 women with severe preeclampsia were randomly assigned to receive either nimodipine (60 mg orally every 4 hours) or intravenous magnesium sulfate (given according to the institutional protocol) from enrollment until 24 hours post partum. High blood pressure was controlled with intravenous hydralazine as needed. The primary outcome measure was the development of eclampsia, as defined by a witnessed tonic-clonic seizure. RESULTS: Demographic and clinical characteristics were similar in the two groups. The women who received nimodipine were more likely to have a seizure than those who received magnesium sulfate (21 of 819 [2.6 percent] vs. 7 of 831 [0.8 percent], P=0.01). The adjusted risk ratio for eclampsia associated with nimodipine, as compared with magnesium sulfate, was 3.2 (95 percent confidence interval, 1.1 to 9.1). The antepartum seizure rates did not differ significantly between groups, but the nimodipine group had a higher rate of postpartum seizures (9 of 819 [1.1 percent] vs. 0 of 831, P=0.01). There were no significant differences in neonatal outcome between the two groups. More women in the magnesium sulfate group than in the nimodipine group needed hydralazine to control blood pressure (54.3 percent vs. 45.7 percent, P<0.001). CONCLUSIONS: Magnesium sulfate is more effective than nimodipine for prophylaxis against seizures in women with severe preeclampsia. (+info)
Maternal transcranial Doppler in pre-eclampsia and eclampsia.
(24/167)
Pre-eclampsia affects 3-7% of women and is associated with significant maternal and perinatal morbidity and mortality. Transcranial Doppler (TCD) has been used in pre-eclampsia/eclampsia to evaluate non-invasively the cerebrovascular hemodynamics in the maternal middle cerebral artery. TCD has demonstrated in pre-eclamptic women maternal cerebral vasospasm, which does not correlate with mean arterial pressure assessed simultaneously. Estimated cerebral perfusion pressure, assessed using a modified formula, has been shown to be increased in women with severe and non-severe pre-eclampsia. However, in severe pre-eclampsia, elevated cerebral perfusion pressure is counterbalanced by increases in cerebrovascular resistance and cerebral blood flow is unaffected. In eclampsia a significant fall in cerebral vascular resistance occurs which, in the presence of increases in cerebral perfusion pressure, leads to hyperperfusion. Cerebral vascular changes to date have not been sensitive enough to predict the development of pre-eclampsia or eclampsia. Longitudinal studies with the aim of predicting the onset of pre-eclampsia and to assess the effects of various drugs on the maternal cerebral circulation need to be designed. (+info)