Gregory W Kirschen1, Katerina Hoyt2, Emily Johnson2, Silka Patel3. 1. Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD 21287, United States. Electronic address: Gkirsch7@jh.edu. 2. Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD 21287, United States. 3. Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD 21287, United States. Electronic address: Spatel87@jhmi.edu.
Abstract
BACKGROUND: Eclampsia is a pregnancy complicationcharacterized bygeneralized tonic-clonicconvulsions.Not all seizures in pregnancy are eclamptic, and othercauses include epilepsy, infection,stroke,tumor, and ruptured aneurysm. CASE: A 19-year-old G1P0 presentedinlabor at term. She had a generalized tonic-clonicseizure one hour aftervaginaldelivery for which she received methergine for uterine atony. Seizure activity resolved with lorazepam and magnesium sulfate for presumed eclampsia.Brain imaging revealedvasoconstriction of theleftposterior cerebral artery and blood in the subarachnoid space,andshewas diagnosed with eclampsia with reversible cerebral vasoconstrictive syndrome (RCVS). CONCLUSION: RCVS isapregnancy-related cause of seizure that should remain on the differential for any patient presenting with a seizure in the peripartum period, especially with use of vasoconstrictive agents. Management is controversial but involves calcium channel blockers and magnesium sulfate, as well as avoidance of vasoconstrictive agents.
BACKGROUND: Eclampsia is a pregnancy complicationcharacterized bygeneralized tonic-clonicconvulsions.Not all seizures in pregnancy are eclamptic, and othercauses include epilepsy, infection,stroke,tumor, and ruptured aneurysm. CASE: A 19-year-old G1P0 presentedinlabor at term. She had a generalized tonic-clonicseizure one hour aftervaginaldelivery for which she received methergine for uterine atony. Seizure activity resolved with lorazepam and magnesium sulfate for presumed eclampsia.Brain imaging revealedvasoconstriction of theleftposterior cerebral artery and blood in the subarachnoid space,andshewas diagnosed with eclampsia with reversible cerebral vasoconstrictive syndrome (RCVS). CONCLUSION: RCVS isapregnancy-related cause of seizure that should remain on the differential for any patient presenting with a seizure in the peripartum period, especially with use of vasoconstrictive agents. Management is controversial but involves calcium channel blockers and magnesium sulfate, as well as avoidance of vasoconstrictive agents.
Authors: T-J Song; K H Lee; H Li; J Y Kim; K Chang; S H Kim; K H Han; B Y Kim; A Kronbichler; A Ducros; A Koyanagi; L Jacob; M S Kim; D K Yon; S W Lee; J M Yang; S H Hong; R A Ghayda; J W Kang; J I Shin; L Smith Journal: Eur Rev Med Pharmacol Sci Date: 2021-05 Impact factor: 3.507