Neurological Complications of Eclampsia
Keywords:
Eclampsia, Neurological complications, Phenytoin, CVAAbstract
Objective: Neurological complications contribute significantly to maternal mortality in eclampsia. We studied neurological and obstetric outcome of such patients.
Material and Methods: A descriptive study was done at Gynaecology, Neurosurgery and Neurology Units of PGMI Lady Reading Hospital Peshawar, from January 2008 to December 2008. A total of 132 cases of eclampsia were included. Twenty seven cases of eclampsia with neurological complications were studied. We excluded cases with primary neurological abnormalities.
Results: During this period one hundred and thirty two patients were admitted with eclampsia. Among 132 cases 27 had neurological abnormalities. One hundred and eight cases were antenatal and twenty four were postnatal. None of them had any antenatal care. Management included initial stabilization followed by early delivery in antenatal cases. Primary anticonvulsant was magnesium sulphate. Phenytoin controlled convulsions in all cases with recurrent seizures. Neurological complications were seen in twenty seven patients. Minor complications like transient impairment of consciousness (97%), blurred vision (22.22%), and Bell’s palsy (07.40%) were observed. Serious neurological complications like CVA (11.11%), recurrent seizures (37.03%) and deep coma occurred in (22.02%) of cases. The cesarean section rate was 18%. Fifty four perinatal deaths and five maternal deaths were recorded. Neurological recovery was complete in all survivors.
Conclusion: Critical care backup is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia. High mean arterial pressure and accompanying coagulation defects may be key factors in cerebral pathology. CT scan is a simple and effective investigation in these cases. Phenytoin is an effective second line anticonvulsant. Early delivery prevents worsening of systemic status.
References
2. Barton JR, Sibai BM. Cerebral pathology in eclampsia. Clin Perinatol 1991; 18: 891-910.
3. Donaldson JO. Eclampsia. Neurology of pregnancy. London: WB Saunders, 1989: 269-310.
4. Hallak M. Hypertension in pregnancy. High risk preg-nancy – management options. 2nd ed. London: WB Sau-nders 1999.
5. Richards A, Graham D, Bullock R. Clinicopathological study of neurological complications due to hypertensive disorders of pregnancy. J Neorol Neurosurg Psychiatry 1988; 51: 416-21.
6. Milliez J, Dahoun A, Boudern M. Computed tomogra-phy of the brain in eclampsia. Obstet Gynaecol 1990; 75: 975-80.
7. Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy: findings on CT, MR imaging. Ameri-can Journal of Radiology 1992; 1559: 379-83.
8. Duncan R, Hadley D, Bone I, et al. Blindness in eclam-psia. CT and MR imaging. J Neurol Nerosurg Psychi-atry 1989; 52: 899-902.
9. Sanders TG, Clyman DA, Sanchez-Ramos L, et al. Brain in eclampsia: MR imaging with clinical correla-tion. Radiology 1991; 180: 475-78.
10. KB Varner MW, Osborn AG, et al. Cranial magnetic resonance imaging in severe preeclampsia v eclampsia. Arch Neurol1993; 50: 399-406.
11. Holdcraft A, Gibberd FB, Hargrove RL. Neurological complications with eclampsia, Audit and risk assess-ment. Br J Anaesth 1995; 75: 522-26.
12. Chakravarty A, Chakravarty SD. The Neurology of eclampsia, some observations. Neurology India. 2002; 502: 128-35.
13. Shmorgan D, Chan WS, and Ray JG. Association bet-ween Bell’s palsy in pregnancy and pre eclampsia. Q J Med 2002; 95: 359-62.
14. Richard B. Schwartz G. Steven K. Feske, Joseph F, Po-lak. Clinical and neuroradiographic correlates and ln-sight into the pathogenesis of hypertensive encephalo-pathy. Radiology. 2000; 217: 371-37.
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