11 aug. 2008 SINDROMUL ENCEFALOPATIEI POSTERIOARE REVERSIBILE LA O PACIENTA CU PREECLAMPSIE
C. Variu*, V. Dorca**
*Catedra ATI, UMF “Iuliu Hațieganu”, Cluj-Napoca
**Clinica de Obstetrică-Ginecologie II “D. Stanca”
Rezumat
O pacientă în vârstă de 28 ani, cu data ultimei menstruații în urmă cu 29 de săptămâni se internează cu diagnosticul IIIGIIIP Ss25, Preeclampsie formă severă, Sindrom HELLP, hipotrifie fetală, Oligoamnios. În dimineața următoare starea ei se agravează și se decide terminarea sarcinii, de urgență, în scop vital matern prin oerație cezariană, în anestezie generală.
După tratament suportiv, antihipertensiv și depletiv cerebral evoluția este rapid favorabilă și pacienta se externează la 15 zile de la internare în stare generală bună, fără sechele neurologice. După analza cazului și consultarea literaturii de specialitate se consideră că diagnosticul neurologic cel mai probabi este cel de encefalopatie posterioară reversibilă.
Abstract
This is the case of a 28 years old pregnant woman who was presented at 29 weeks gestation with a week history of headache and lower extremity swelling. Her blood pressure was elevated in the last month and she received antihypertensive treatment. She was admitted with a diagnosis of pre-eclampsia and magnesium-sulfate therapy was began, Labortaory investigations showed raised transaminase (GOT=17U/l, GPT=156U/l), low platelets (17.000/mm3) and a packed cell volume of 33.5 Î, consistent with HELLP syndrome (haemolysis, elevated liver enzymes, low platelets).
Next morning she became confuse, drowsed and began to complain of epigastric pain, nausea and visual disturbance (diplopia). Emergency cesarean section was performed undr general anesthesia. After wxtubation she became comatose and developed respiratory failure and she was re-intbated and entilated. Neurological examination, made five hours later, revealed a conscious but sleepy patient with flaccid quadriplegia, areflexia, partial palsy of left oculomotor nerve, lateral gaze-evoked ongoing nystagmus bilaterally without an extensor plantar response (Babinski) or signs of meningeal injury. With appropiate blood pressure control and supportive care her condition improved, the neurological deficits resolved and she was extubated after 10 hours. The diagnostic established for the neurologic disorder was reversible posterior encephalopathy syndrome.