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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty four women with severe pre-eclampsia diagnosed before 34 weeks' gestation were compared with 48 randomly selected controls matched for age and parity. Subjects were studied in the puerperium using a questionnaire, clinical examination, and review of case records. A history of infertility, headaches (particularly migraine), pre-eclampsia in a previous pregnancy, or a raised serum alpha-fetoprotein concentration at the time of screening for neural tube defect in the index pregnancy were all identified as significant risk factors in the pre-eclamptic women. Maternal age, a history of chronic hypertension or renal disease, or excessive maternal weight were not significantly associated with pre-eclampsia. Almost all the infants of pre-eclamptic women showed retarded growth: 18 were below the 10th centile and only one weighed more than the 25th centile. Four babies died. These observations indicate that pre-eclampsia of early onset may differ from the late onset disease not only in its very high perinatal morbidity and mortality but in its distinctive maternal risk factors.
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PMID:Case-control study of severe pre-eclampsia of early onset. 641 Dec 32

Eclampsia occurring more than 48 hours postpartum has been observed in an unusual number of patients. From August 1977 to November 1982 at E. H. Crump Women's Hospital and Perinatal Center (Memphis), there were 132 documented cases of eclampsia, of which 36 (27%) occurred postpartum. Seventeen (47%) of these occurred more than 48 hours postpartum. Preeclampsia was diagnosed before the onset of convulsions in 12 patients, all of whom received intravenous magnesium sulfate postpartum. The mean duration of postdelivery magnesium sulfate therapy was 32 hours (range 24 to 72 hours). Headaches and visual disturbances were reported by all 17 patients before onset of convulsions. Physical and laboratory findings immediately after the convulsions were consistent with eclampsia. Treatment consisted primarily of intravenous magnesium sulfate. Neurologic consultation was obtained to rule out a neurologic disorder, and metabolic studies were also done. Electroencephalograms were done on 15 patients; eight of them showed patterns consistent with encephalopathy.
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PMID:Late postpartum eclampsia: an update. 664 9

Isolated angiitis of the brain in labor and puerperium is described. Persistent headaches in a preeclamptic patient in the postpartum period usually suggests either persistent preeclampsia or subarachnoid hemorrhage. Isolated vasculitis of the brain, which was diagnosed in the present case, should be considered as it responds to medical (pharmacologic) treatment.
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PMID:Isolated angiitis of brain in pregnancy and puerperium. 670 Sep 6

The perceptive physician can anticipate and prevent eclampsia. If possible, he should try to prolong preeclamptic pregnancies to the 37th week to avoid neonatal deaths from complications and prematurity. In some cases, preeclampsia strikes and progresses rapidly before the 30th week, however, and, in order to save the mother, the pregnancy must be terminated. If the preeclamptic woman deteriorates to the point where severe headache, epigastric pain, vomiting, and hyperreflexia exist, eclampsia is imminent. If she becomes eclamptic, clinicians must immediately begin to manage the convulsions with a sedative. Diazepam has proved successful which accounts for its widespread use in Great Britain and developing countries. Large doses given over a long period of time, however, adversely affect the newborn, e.g. respiratory depression. Another popular sedative is magnesium sulphate (in use for 50 years). Dangers of overdose can be avoided by testing the patella reflex every hour when magnesium sulphate is being administered intravenously: the reflex becomes null before serious toxic effects occur. If the systolic blood pressure exceeds 170mmHg, antihypertensives should also be given selectively to prevent cerebral hemorrhage. The preferred antihypertensive must act rapidly and predictably, with a wide margin of safety between the therapeutic and toxic dose. Hydralazine hydrochloride meets these requirements. Fluid and acid-base balances must be controlled to treat hypovolemia, oliguria, and acidosis. The longer delivery is delayed, the worse the outlook for mother and infant. Regardless of the type of delivery, clinicians must avoid hemorrhage and operative shock because eclamptics cannot tolerate blood loss. It is imperative that clinicians do not become so involved in saving the patient that they overtreat her, e.g., mixing antihypertensives.
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PMID:Eclampsia. 675 54

A case of brain tumor complicating a full-term pregnancy is reported. The literature is reviewed to show the effect of pregnancy on these tumors, the method of diagnosis, and management. Pregnancy often unmasks the existence of an intracranial neoplasm. The diagnosis can easily be missed, as the symptoms such as headache, vomiting, visual disturbance etc. are often encountered in pregnancy with or without pre-eclampsia. A high index of suspicion on the part of the obstetrician is a key to timely diagnosis. Computerized axial tomography is extremely useful in confirming or refuting the diagnosis of brain tumor. Generally speaking, neurosurgical intervention is best deferred until after delivery. In most cases, pregnancy may be allowed to continue under close supervision until the baby is reasonably mature. Labor may be induced in suitable cases, and the baby should be delivered by elective forceps as soon as the second stage of labor is reached to cut down maternal bearing-down efforts.
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PMID:Brain tumors and pregnancy. Presentation of a case and a review of the literature. 719 55

Midwives must be alert to the possibility of pre-eclampsia by: Taking accurate and detailed genetic histories. Taking consistent blood pressure measurements. Testing urine for protein at every visit. Observing generalised oedema. Advising clients that headaches and epigastric pain should not be ignored. Fetal monitoring for intrauterine growth retardation.
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PMID:Pre-eclampsia I: the midwife and detection. 787 26

Two cases of neurological dysfunction are presented. Neurological deficits after recovery from anaesthesia are unusual in young women perioperatively. In the first case, a 39-yr-old woman presented at 36-wk gestation with antepartum haemorrhage and in labour. Pregnancy had been complicated by pre-eclampsia and she underwent emergency Caesarean section under general anaesthesia without complication. The trachea was extubated when she was awake but almost immediately she became hypertensive, obtunded and reintubation was required. Her pupils became fixed and dilated but the Computerised Axial Tomogram (CT) was normal. A coagulopathy was evident. She made a full neurological recovery within 24 hr. On the same day, a previously healthy 41-yr-old woman who had undergone uneventful surgery for uterine prolapse 24 hr previously developed headache, nausea and over the next four hours signs of progressive brainstem ischaemia. The CT scan showed oedema of the mid- and hindbrain. Brainstem death was confirmed 12 hr later and the post-mortem revealed acute dissection of the vertebral artery secondary to cystic medial necrosis. Such dramatic neurological sequelae are rare but the importance of identifying "at risk" groups is underlined as is early recognition of neurological injury postoperatively.
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PMID:Unexpected neurological deficits following recovery from anaesthesia. 800 39

Panic disorder is a specific psychiatric entity with specific and successful treatments. A parturient patient with sudden hypertension, hyperreflexia and headache was diagnosed with pre-eclampsia and treated with magnesium sulphate. Further attacks after discharge were recognized as panic attacks, and resolved with the anti-depressant imipramine.
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PMID:Panic disorder masquerading as pre-eclampsia. 828 46

Sudden bleeding in the advanced stage of pregnancy is usually caused by abruptio placentae. Pre-eclampsia may develop rapidly into eclampsia and should lead to immediate hospitalization of the patient. A pregnant woman suffering from high blood pressure, headaches and epigastric pains, might be developing the life threatening HELLP syndrome. Sudden labour at term, either at home or in the ambulance, does not usually involve major complications. Hypothermia of the newborn baby should be avoided by drying it and placing it at the mother's breast. The umbilical chord is cut at the obstetrical department.
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PMID:[Emergency obstetrics]. 832 52

The purpose of this study was to determine whether women who had no clinical evidence of preeclampsia at delivery, but who were later readmitted with postpartum severe preeclampsia or eclampsia, differed in mean arterial pressure (MAP) and clinical presentation from women who either remained normotensive or had severe preeclampsia or eclampsia at the time of delivery. Control subjects did not require readmission and were matched (2:1) with study subjects in consecutive order for date of delivery and maternal age, race, and parity. Women in the study group had a significantly greater increase in MAP after delivery than control subjects, and analysis of variance for linear trends demonstrated highly significant differences between the study and control groups in the average intrapartum and postpartum MAPs. Compared to women in either control group, mothers who were readmitted were significantly more likely to demonstrate a > 10-mm Hg increase in MAP between the intrapartum and postpartum periods (delta MAP). Normotensive women with a delta MAP > 10 mm Hg had more than a threefold risk of readmission in the postpartum period with severe preeclampsia or eclampsia. Women who were readmitted reported a significantly greater frequency of headaches and nausea and vomiting than women with intrapartum preeclampsia. In summary, our findings indicate that MAP increase following delivery in normotensive women who were later readmitted with severe preeclampsia or eclampsia.
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PMID:Blood pressure changes in normotensive women readmitted in the postpartum period with severe preeclampsia/eclampsia. 879 94


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