Antepartum eclampsia with reversible cerebral vasoconstriction and posterior reversible encephalopathy syndromes

Abstract

A 39-year-old pregnant woman was experienced thunderclap headache due to reversible cerebral vasoconstriction syndrome (RCVS) as a prodromal symptom. Two days after, she was brought to our hospital after an eclamptic seizure at 35 weeks of gestation. After management with magnesium sulphate, a cesarean delivery was performed, and passed without eclamptic seizure recurrence with calcium channel blocker (CCB) administration for hypertension and prophylaxis of another seizure. Antepartum eclampsia is sometimes complicated by headache as a prodromal symptom. Cerebrovascular diseases in the perinatal period include eclampsia, RCVS and posterior reversible encephalopathy syndrome, which have potentially overlapping pathologies. Here, we first report a case of overlapping those three diseases in the antepartum period. Our best literature review showed that antepartum RCVS is severe and has complications besides thunderclap headache, and there is a case report which CCB administration was shown to be effective in the treatment of antepartum RCVS. If thunderclap headache is recognized, prediction of eclampsia and getting better course of RCVS with CCB administration may be possible.

Reversible cerebral vasoconstriction syndrome: literature review

“…Regarding CCBs, intravenous and oral nimodipine, with a dosage of 30–60 mg every 4 h [ 64 ], is best described in the improvement of headache [ 74 ] in 64–83% of patients [ 1 , 11 , 17 , 75 ]. In the form of an infusion of this drug, the dosage of one to two mg/h has been described.…”

Eclampsia with hypothyroidism complicated with posterior reversible encephalopathy syndrome–a case report

“…An interesting observation in this case was that RCVS, which usually occurs during the delivery/postpartum period [18], occurred before eclampsia, which to the best of our knowledge has not previously been reported as a pre-eclampsia symptom until now. This suggests that a RCVS imaging examinations in pregnant women with severe headache before the attack of eclampsia may be conductive to early diagnosis [19]. Some studies have demonstrated that the early use of calcium channel blockers (CCBs, such as nimodipine) could contribute to stabilizing vasoconstriction and distal arteriole vasodilation in 64-83% of patients [13], however, this still remains a controversial treatment for prenatal eclampsia.…”

Krampfanfall mit intrakraniellen Blutungen nach Sectio caesarea in Spinalanästhesie

“…die postpartale Phase -in zwei Drittel der Fälle tritt das RCVS in der ersten Woche nach der Entbindung auf. Es existieren Fallberichte zu koinzidentem Auftreten von RCVS und Eklampsie [14]. AuchbestimmteVorerkrankungen (Phäochromozytom, Porphyrie) oder neurochirurgische Operationen könnenprädisponieren [4], ebenso vasoaktive Substanzen wie Amphetamine, Cannabis, Kokain, Triptane und Antidepressiva [1,3,9,10].…”

“…Therapeutische Ansätze beinhalten v. a. die Unterbindung der auslösenden Triggerfaktoren nach Möglichkeit, die symptomatische Behandlung der Kopfschmerzen, die Vermeidung von Blutdruckentgleisungen sowie eine Therapie mit Nimodipin (Kalziumkanalblocker, Off-label-Gebrauch gemäß Anwendung bei einer aneurysmatischen SAB) [1,13]. Für Letztere existieren auch Berichte zu positiven Verläufen im Falle der Koinzidenz mit einer Eklampsie, in der Präpartalphase sind jedoch immer die Auswirkungen auf den fetalen Kreislauf zu beachten [14]. Empfohlen wird die Überwachung am Monitor.…”