Start/Search | Browse by Day | Author Index

IN A PATIENT WITH ECLAMPSIA

Posterior Reversible Encephalopathy syndrome (PRES) is a relatively rare central nervous system complication that was first described in 1996. MRI images confirm the diagnosis where abnormalities in both gray and white matter and vasogenic edema may be seen. These changes can result in hypertensive crisis. PRES may result in headaches, visual disturbances and seizures. The prognosis is good when treated promptly, but misdiagnosis may occur easily, and delayed diagnosis and treatment can result in permanent damage.

Our case study describes a 24 year old primipara who had her prenatal care in another state. Her husband found her at home having seizures and called 911. The respondents stated that the patient was unresponsive and noticed tongue lacerations. The patient was transported to our hospital, where it was determined that she was 32 weeks gestation in our OB triage unit. She had had another seizure in the ambulance, and seized again in OB triage. She had blood pressures greater than 170/110. Magnesium Sulfate and Hydralazine were administered, and then a C-Section was performed with the operative diagnosis of eclampsia. A viable male was delivered weighing 3lbs3oz (1446 grams) with Apgars of 2/5/6. The newborn was transferred to the Newborn Intensive Care Unit, and the mother was transferred to our OB High Risk Unit from the OR.

Postoperatively, the patient underwent a CAT scan and then an MRI to provide a definitive diagnosis. The patient was seen by a neurologist. Her blood pressures remained uncontrolled according to arterial line readings, so she was transferred to the surgical intensive care unit for a continuous antihypertensive medication infusion. Once stabilized, she was transferred back to our OB High Risk Unit. The patient was discharged six days after she delivered with a prescription for oral antihypertensives and no obvious lasting neurological deficits.

A multidisciplinary team contributed to the successful care of this patient. There are other reports in the literature where the outcome was not as successful. The person who read the CAT scan was instrumental in making an immediate recommendation for an MRI. The OB nurses caring for the patient had to quickly try to learn what they could about the unusual diagnosis. The anesthesiologist had to provide expert care and the arterial line. The neurologist provided the obstetricians with recommendations. The Rapid Response Team assisted the OB nurses with the continuous antihypertensive medication infusion. The SICU had to care for a postpartum patient. The lactation consultant had to provide assistance to a critically ill patient.

The happy ending is that the patient went home alive, with a breast pump and a prescription for blood pressure medication. Her baby boy went home 20 days after birth.