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Eclampsia, or toxemia of pregnancy, is a disorder of pregnancy characterized by seizures associated with hypertension, edema, and proteinuria. Toxemia carries significant maternal and fetal morbidity and mortality. Psychogenic seizures are defined as events that clinically resemble epileptic seizures but are not accompanied by abnormal electrical activity of the cerebral cortex. We report the case of a third trimester pregnant patient who presented with new onset convulsive activity that was associated with peripheral edema, intermittent hypertension, and proteinuria. The initial impression of the treating physicians--emergency medicine, obstetrical, and neurology--was toxemia of pregnancy. After further review and the application of numerous procedures and therapies with potential risk, the diagnosis of psychogenic seizure was made.
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PMID:Pseudotoxemia: new onset psychogenic seizure in third trimester pregnancy. 940 98

Eclampsia is a rare condition peculiar to pregnant and puerperal women, characterized by clinical pre-eclampsia (hypertension, proteinuria, edema) and generalized seizures. Three cases of eclamptic encephalopathy are reported: CT and MRI demonstrated transient abnormalities in the cortical and subcortical regions of the posterior areas of the brain - namely, parieto-occipital lobes - associated with occasional involvement of basal ganglia and/or brainstem. Pathogenesis is still unclear. Strict similarity with the pathological findings characterizing hypertensive encephalopathy suggests that a focal impairment in cerebral autoregulation may be the cause of vasodilation and fluid extravasation leading to hydrostatic edema; selective involvement of posterior areas could be explained by their lesser degree of adrenergic innervation supporting circulatory autoregulation mechanisms.
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PMID:Eclamptic encephalopathy: imaging and pathogenetic considerations. 940 96

Pregnant women with hypertension can be divided into two groups: normotensive women who develop the uniquely pregnancy-related syndrome of preeclampsia, which is characterized by hypertension, proteinuria, and edema; and women with chronic hypertension who become pregnant and are at increased risk for developing superimposed preeclampsia. Preeclampsia is a syndrome of generalized endothelial dysfunction initiated by abnormal placentation and consequent placental under-perfusion, release of cytokines and other toxins, and vasoconstriction and platelet activation. Preeclampsia is the major cause of both maternal and fetal morbidity and mortality and may be complicated by eclampsia (seizures) and hepatic and renal failure. The process is completely reversible by delivery of the fetus and placenta, but intrauterine growth retardation and premature delivery pose major threats to the fetus and may require care in tertiary care center. Treatment of preexisting or pregnancy-induced hypertension does not prevent or reverse the process, but is justified to prevent maternal cardiovascular complications, especially during labor and delivery.
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PMID:Hypertension and pregnancy-related hypertension. 950 83

In this assay, we evaluated the utility of isosorbide given by a sprayer in the management of hypertensive crisis of severe preeclampsia. 36 pregnant women with severe preeclampsia received fluid therapy and were randomly dividend in two groups of 18 patients each. Group A, received isosorbide in spray 1.25 mg when admitted and a second dose 10 minutes after if mean arterial blood pressure decreased less than 15%. and group B, in whom 4 g of magnesium sulphate was infused in one hour and then 1 g each hour for a maximum of five hours. In all patients blood pressure, proteinuria, fetal and maternal heart rate and Apgar score at minute and five minutes were obtained. In Group A 13 patients had a significative blood pressure reduction with one application and 5 needed a second one (p < 0.002). fetal (p < 0.005), and maternal (p < 0.005) heart rate also had a significative reduction. Whereas three patients in Group B did not respond and the rest had a poor blood pressure control (p > 0.05) with no changes in fetal and maternal heart rate. No patient developed eclampsia. When compared both groups, there were a significative difference for blood pressure (p < 0.005), fetal heart rate (p < 0.002), maternal heart rate (p < 0.05) and Apgar at minute (p < 0.01) in isosorbide's group. Our data suggest that isosorbide given by a sprayer is effective and safer in the management of the hypertensive crisis of severe preeclampsia.
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PMID:[Efficacy of isosorbide in aerosol form in the management of hypertensive crisis in severe preeclampsia]. 974 91

Eclampsia, accompanied by convulsions, is one of the most dangerous complications of pregnant women. This condition was known to the ancient Greeks, who named it eclampsia. Prior to the 18th century, the term eclampsia was used only to refer to the visual phenomena which accompanied the neurologic aspects of the malady. Rayer's landmark contribution (1839-1841) provided evidence for renal involvement with the observation of protein in the urine of pregnant, edematous women. Lever (1843) reported finding proteinuria in eclampsia and concluded that disappearance of proteinuria after delivery of the child was evidence that eclampsia was different from Bright's disease.
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PMID:A history of eclampsia, toxemia and the kidney in pregnancy. 1021 34

High blood pressure during pregnancy (BP > or = 140/90 mmHg) is sometimes already noted before conception, with usually a good prognosis (although it could predispose to preeclampsia). alpha-methyldopa is the best treatment when needed (agents blocking the renin angiotensin system are not recommended). Preeclampsia, a form of hypertension noted after 20 weeks of gestation with proteinuria is a more serious condition (BP > or = 140/90 mmHg or increase in BP from the 1st trimester > or = 25/15 mmHg). It is generated by placental ischemia and creates maternal endothelial lesions which in turn decrease the blood flow to placenta leading to maternal and fetal syndromes. Hospitalisation is mandatory. No measure other than delivery is known to attenuate or reverse its progression. Treating hypertension during pregnancy (when blood pressure > or = 170/110 mmHg) aims at preventing maternal risk (stroke or eclampsia) but has few effect on foetal lesions. Prevention of this syndrome, which represents the first secondary cause of hypertension, is until now disappointing.
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PMID:[Hypertension at pregnancy]. 1039 40

Pre-eclampsia is a common and serious disease and a major cause of maternal and infant mortality. Antenatal care systems world-wide screen for signs of the disease such as hypertension and proteinuria. Unlike most other human disorders it impacts two individuals, the mother and the child, both of whom can be severely affected. The pathophysiology of the disorder is incompletely understood, but familial clustering of the disease is apparent. Here we report the results of a genome-wide screen of Icelandic families representing 343 affected women. Including those patients with non-proteinuric pre-eclampsia (gestational hypertension), proteinuric pre-eclampsia and eclampsia, we detected a significant locus on 2p13 with a lod score of 4.70 (single point P < 3.49 x 10(-6)). This is the first reported locus for pre-eclampsia meeting the criteria for genome-wide significance.
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PMID:A genome-wide scan reveals a maternal susceptibility locus for pre-eclampsia on chromosome 2p13. 1044 46

Hypertension in pregnancy is defined by a systolic blood pressure > or = 140 mm Hg and a diastolic blood pressure of > or = 90 mm Hg or by a rise in blood pressure of systolic > or = 30 mm Hg and diastolic > or = 15 mm Hg. High blood pressures are found in 5-10% of all pregnancies. The outcome of pregnancy is influenced by the fact whether there occurs a proteinuria in addition to hypertension. While the prognosis of an isolated hypotension is good, the combination of hypertension and proteinuria leading to preeclampsia is the primary cause of maternal death in many countries and is responsible for 20-25% of perinatal mortality. A simple classification divides between chronic hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension and transient hypertension. With chronic hypertension pregnancy outcome is determined by a preexisting nephropathy and the occurrence of a superimposed preeclampsia. Preeclampsia and superimposed preeclampsia are pregnancy induced multiorganic diseases, endangering both the mother and the fetus. Transient hypertension is a benign pathology, which occurs toward the end of pregnancy usually on the basis of a latent essential hypertension, which is laid open through pregnancy. While a severe chronic hypertension in pregnancy must be treated to prevent a hypertensive maternal encephalopathy, a less severe chronic hypertension should not be treated as the risk of a superimposed preeclampsia and the maternal and fetal outcome cannot be influenced by antihypertensive therapy. The incidence of preeclampsia is 3-5% in nulliparae and 0.5% in multiparae. Preeclampsia is a severe and dangerous pathology with an unknown etiology. Pregnancy termination is the only causal therapy. At present it is still recommended to terminate a severe preeclampsia after stabilizing the mother, irrespective of gestational age. In less severe preeclampsia occurring before 32 weeks of gestation, termination of pregnancy can be postponed under intensive monitoring and a prophylaxis with magnesium sulfate in order to accelerate the fetal lung maturation with glucocorticoids. A conservative management in the case of a HELLP-syndrome (Haemolyis, Elevated Liver enzymes, Low Platelets), which is a very severe form of preeclampsia, is not recommended because it hasn't been validated in prospective controlled studies. The most dangerous complication of preeclampsia is eclampsia, which is defined by general tonic-clonic convulsions before or after birth. The most effective prophylaxis of eclamptic attacks is the intravenous therapy with magnesium sulfate. A primary prohylaxis for preeclampsia doesn't exist. Treatment with low-dose aspirin in high-risk patients, i.e. after a severe preeclampsia, in cases of chronic hypertension, in cases of nephropathy and in cases with antiphospholipid-syndrome++ can be recommended. The prophylactic use of low-dose heparin, which has lead to a significant decreased incidence of preeclampsia in retrospective analysis, is now the object of a randomized, controlled trial in our hospital. All women who suffered from a preeclampsia should have a check-up after 3-6 months. Preexisting pathologies are found in up to 40% of patients, mostly in multiparae, i.e. chronic hypertension, nephropathy, endocrine pathologies, anomalies of blood coagulation and antiphospolipid-syndrome.
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PMID:[Hypertensive disorders in pregnancy]. 1054 28

Eclampsia is defined as the occurrence of seizures in pregnancy or within 10 days of delivery, accompanied by at least two of the following features documented within 24 hours of the seizure: hypertension, proteinuria, thrombocytopenia or raised aspartate amino transferase. Eclampsia complicates approximately one in 2,000 pregnancies in the United Kingdom and it remains one of the main causes of maternal death. Up to 38% of cases of eclampsia can occur without premonitory signs or symptoms of pre-eclampsia-that is, hypertension, proteinuria, and oedema. Only 38% of eclamptic seizures occur antepartum; 18% occur during labour and a further 44% occur postpartum. Rare cases of eclampsia have occurred over a week after delivery. Outcome is poor for mother and child. Almost one in 50 women suffering eclamptic seizures die, 23% will require ventilation and 35% will have at least one major complication including pulmonary oedema, renal failure, disseminated intravascular coagulation, HELLP syndrome, acute respiratory distress syndrome, stroke, or cardiac arrest. Stillbirth or neonatal death occurs in approximately one in 14 cases of eclampsia. Up to one third of eclamptic seizures occur out of hospital. For this reason, initial management may involve accident and emergency departments. Early involvement of senior obstetric staff is crucial. Optimal emergency management of seizures, hypertension, fluid balance and subsequent safe transfer is essential to minimise morbidity and mortality.
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PMID:Management of eclampsia in the accident and emergency department. 1065 82

In two patients eclampsia started 9 days postpartum. Headache and visual disturbances preceded seizures but none of the classic pre-eclamptic signs oedema, proteinuria, and hypertension were present until shortly before seizure onset. Brain herniation (patient 1) and status epilepticus (patient 2) necessitated neurointensive care management. Brain MRI initially showed only frontal sulcal effacement in one patient but later showed white matter hyperintensities on T2 weighted images and a previously undescribed pattern of cortical-subcortical postgadolinium enhancement on T1 weighted images in both. Neurological deficits and MRI findings were reversed with therapy in both patients. It is concluded that late postpartum eclampsia can manifest without classic prodromi and that characteristic MRI findings may lag behind clinical manifestation.
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PMID:Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients. 1108 Feb 41


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