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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 23-year-old woman who had an uneventful prenatal course and normal delivery developed severe, generalized headache and blurred vision on postpartum day four. The patient was noted to have generalized hyperreflexia and sustained ankle clonus. The blood pressure was 170/100 mm Hg, there was no edema, and the urine showed trace proteinuria. The visual disturbance rapidly progressed to complete blindness with preserved pupillary reactions. The patient then had a generalized tonic-clonic seizure lasting about one minute. Treatment was initiated with intravenous diazepam and phenytoin, and there was no recurrence of seizure activity. Vision returned to normal and the patient made a complete recovery. This case is presented to demonstrate progressive postpartum pre-eclampsia and the importance of early recognition and treatment. Pathophysiologic mechanisms and treatment options are discussed.
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PMID:Cortical blindness in postpartum preeclampsia progressing to eclampsia: case report. 173 43

Retinal detachment is an unusual complication of hypertensive disorder in pregnancy. It has been reported in 1% to 2% of patients with severe preeclampsia and in 10% of patients with eclampsia. Choroidal ischemia may be the cause of retinal detachment. We know that mild arteriolar spasm involving the bulbar conjunctival vessels has been observed in the normal pregnancy, but in pregnancy-induced hypertension the vasospasm may be severe and result in choroidal ischemia. Most patients with retinal detachment in pregnancy-induced hypertension have had full spontaneous resolution within a few weeks, and they did not have any sequelae. Medical treatment with antihypertensive drugs and steroids may be helpful. We report two rare cases of retinal detachment and persistent hypertension in association with postpartum eclampsia and post-cesarean section preeclampsia. These patients had normotension throughout pregnancy. Preeclampsia or eclampsia developed after delivery, and blurred vision, headache, and reduced vision accompanied serous retinal detachment. The serous retinal detachment disappeared within 3 weeks. Good outcomes were found in the follow-up examinations in both of these cases. For women who had been normotensive at the time of delivery and then complained in the postpartum period of blurred vision, headaches, nausea and vomiting, we should consider the possibility of retinal detachment and perform fundoscopy.
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PMID:Retinal detachment in postpartum preeclampsia and eclampsia: report of two cases. 1058 29

The coincidence of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and cortical blindness is an uncommon but very dramatic event. We describe a case of HELLP syndrome complicating with acute cortical blindness before delivery. A 27 year-old woman, gravida 1, para 0, with normal medical history, was referred to our emergency department at the 33th week of gestation due to headache, vomiting, and blurred vision. The ophthalmologic examination showed intact pupillary light reflexes and normal ophthalmoscopic findings, but no light perception in either eye. Brain computed tomography showed normal findings. HELLP syndrome and preeclampsia was diagnosed based on the findings of hypertension and proteinuria as well as laboratory data. Prompt delivery was performed in order to achieve good maternal and neonatal outcomes.
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PMID:Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with acute cortical blindness. 1172 Jan 49

Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This is a case report of a 27 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, until she could see only shadows. Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision.
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PMID:Retinal detachment in preeclampsia. 1221 93

We present a case report describing a pregnancy complicated by severe preeclampsia and a trigeminal schwannoma which caused loss of consciousness, diplopia and blurred vision, which were initially thought to be signs of magnesium intoxication.
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PMID:Trigeminal schwannoma mimicking magnesium intoxication in a pregnancy complicated by severe preeclampsia. 1293 22

Intravenously administered magnesium sulfate is effective in reducing the incidence of eclampsia in women with severe preeclampsia. However, the routine use of magnesium sulfate in all cases of preeclampsia is not justified as the incidence of eclampsia is likely to be lower in milder cases than in those with severe disease, and also in view of the adverse effects of magnesium sulfate. Magnesium sulfate should be considered for women with preeclampsia for whom there is concern about the risk of eclampsia, such as hyperreflexia, frontal headache, blurred vision, and epigastric tenderness. As it is an inexpensive drug, it is especially suitable for use in low income countries. Intravenous administration is preferable, where there are appropriate resources, as side effects and injection site problems seem lower. Duration of treatment should not normally exceed 24 hours, and if the intravenous route is used for maintenance therapy the dose should not exceed 1 g/hour Serum monitoring is not necessary. Clinical monitoring of respiration, tendon reflexes and urine out put are enough for monitoring of magnesium toxicity. Administration and clinical monitoring of magnesium sulfate can be done by medical, a midwife or nursing staff provided they are appropriately trained. However, the use of magnesium sulfate should not be misconstrued as a license for reduced surveillance of preeclamptic women. Progression from mild to severe disease and development of serious maternal complications during antepartum, intrapartum and postpartum cannot be predicted without close maternal surveillance. Therefore, continued close antepartum, intrapartum, and postpartum surveillance is crucial for optimal maternal and perinatal outcomes.
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PMID:Is magnesium sulfate for prevention or only therapeutic in preeclampsia? 1624 Oct 34

Just after Caesarean section for twin pregnancy and feto-pelvic dysproportion, a woman presented severe headaches and arterial hypertension, then blurred vision, then generalised seizures. There were no oedematous syndrome, proteinuria was negative, ASAT were 1.5 N and platelet count was 120,000/mm(3). Cerebral CT-scan was normal. Posterior reversible encephalopathy syndrome (PRES) was diagnosed on MRI. A second MRI performed at day 9 showed complete regression of cerebral lesions, while patient was taking anti-hypertensive and antiepileptic drugs. PRES has to be evoked in post-partum central neurological symptoms, even in absence of classical sign of pre-eclampsia, like proteinuria. PRES and eclampsia share probably common physiopathological pathways. There management and prognosis seems identical.
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PMID:[Isolated severe neurologic disorders in post-partum: posterior reversible encephalopathy syndrome]. 1757 73

We conducted a retrospective study of the management and outcome for eclampsia patients in the intensive care unit (ICU) of National hospital, Abuja between November 2001 and April 2005 (42 months). The patients' case files and ICU records were used to extract the necessary data. During the study period, there were a total of 4857 deliveries, with 5051 total births (including multiple births) and 4854 live births. Forty eclamptics were admitted to the ICU, giving an ICU admission rate of 8.2/1000 live births. The records of two patients were incomplete. The average age of the patients was 28.4 years (range 17-4 years). Six patients (15.8%) were booked and 32 (84.2%) were not. The average duration of stay in ICU was 5 days. Twenty patients (52.6%) had antepartum eclampsia, 12 (31.6%) had postpartum eclampsia and six (15.8%) presented with intrapartum eclampsia. Twenty-nine (76.3%) gave birth via caesarean section and nine (23.7%) delivered per vagina augmented by oxytocin infusion. Seventeen (45%) received mechanical ventilation; 20 (53%) received oxygen via nasal prongs, nasal catheters or variable performance facemask. One patient (2%) did not receive oxygen therapy. All the patients were admitted postpartum. There were 11 maternal deaths, giving a case fatality rate of 29%. There were five (45.4%) deaths due to haemolysis, elevated liver enzymes and low platelet count syndrome and two (18.2%) due to disseminated intravascular coagulation. The remaining deaths were due to cerebrovascular accident (9.1%), lobar pneumonia (9.1%), acute renal failure (9.1%) and multiple organ failure (9.1%). All patients were admitted postpartum. This fatality rate is higher than that detailed in the reports reviewed in this study. Early referral of eclamptics or at risk patients to a tertiary care institution may help reduce morbidity and mortality. In addition, early referral to a facility providing basic essential obstetric care or comprehensive essential obstetric care is also important. Another important factor is the correct diagnosis of pre-eclampsia during antenatal and postpartum care by screening, noting blood pressure levels, performing urinalysis for protein and asking about warning signs such as headache, blurred vision, epigastric pain, etc.
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PMID:Critical care management of eclamptics: challenges in an African setting. 1830 51

Neurological findings in preeclampsia fulfill diagnostic criteria of posterior reversible encephalopathy syndrome (PRES), which is related to cerebral autoregulation impairment associated with high blood pressure. In preeclampsia, PRES may occur without a significant increase in blood pressure. Our aim was to investigate the association between ophthalmic artery resistive index (OARI) and clinical evidence of PRES, defined as the presence of headache and blurred vision, in patients with severe preeclampsia. OARI and main clinical and laboratory parameters were obtained in 112 patients with severe preeclampsia. Differences in these parameters were analyzed in the function of clinical evidence of PRES with a 2-sample t test. The area under receiver operating characteristic curve for each of these parameters in the function of clinical evidence of PRES was obtained. Logistic regression models were established with parameters categorized by cutoff points obtained in receiver operating characteristic curves. Among 112 patients with severe preeclampsia, 46 (41%) presented clinical evidence of PRES. These patients presented lower OARI (P<0.0001), higher mean blood pressure at admission (P<0.0001), higher mean blood pressure elevation after the first trimester (P<0.0001), and higher lactate dehydrogenase (P<0.0001) than those without clinical evidence of PRES. OARI presented an area under receiver operating characteristic curve of 0.810+/-0.039 (95% CI: 0.742 to 0.895; P<0.0001). OARI <0.56 was associated with clinical evidence of PRES, with an odds ratio of 12.67 (95% CI: 4.08 to 39.39; P<0.0001). Data suggest that OARI is a relevant biomarker of PRES in severe preeclampsia.
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PMID:Ophthalmic artery-resistive index and evidence of overperfusion-related encephalopathy in severe preeclampsia. 1994 84

Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
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PMID:Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration. 2131 76


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