///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

PRES IN PREGNANCY,MANIFESTING AS NEW ONSET SEIZURE

Abstract Number: 31
Abstract Type: Case Report/Case Series

RANJAN GUPTA M.D.1 ; DONNIE ISSEROFF M.D.2; KALPANA TYAGARAJ M.D.3

INTRODUCTION: A new onset seizure during pregnancy is rare and needs careful evaluation. The etiology can vary from a benign pathology to space occupying intracranial lesion. Here is a case of new onset of seizure in pregnancy where the diagnosis was unclear and uncommon.

CASE REPORT: 22 year old female, at 36 weeks, G1P0, brought in by EMS after an episode of suspected seizure activity witnessed by her husband. He stated he found her with involuntary movements and bleeding from the mouth. Patient denied headache, blurred vision, nausea, vomiting or any prior "aura". No significant medical or obstetric history. She denied drug abuse. On examination, Patient was awake, slightly drowsy and irritable. Trace pedal edema present. Labs: WBC 10.2, Hct 37.4, Platelets 179, Na 142, K 4.2, Cl 109, CO2 21, Bun 7, Creatinine 0.5, glucose 90, PT 9.3, PTT 25.2 , Urine 2+ proteins, Ultrasound revealed breech presentation. Head CT - Focal area of hypoattenuation in the periventricular white matter along right lateral ventricle

Patient was started on Magnesium Sulfate infusion. Patient began to contract and underwent C-Section with no complications, under spinal anesthesia. Postoperatively, neurology consult was done whose impression was Demyelination vs Posterior reversible encephalopathy syndrome (PRES). The plan was to continue Magnesium infusion, obtain MRI and maintain blood pressure below 120 systolic. MRI results abnormal with a non enhancing Ovid lesion in Right occipital lobe. During post partum day two, patient had an episode of diplopia and vertigo. On post partum day four, Neurology cleared patient for discharge with a diagnosis of PRES that was resolving. Patient was to follow up with Neurology.

DISCUSSION: Onset of seizure activity during pregnancy, without any other cerebral pathology, is presumed to be Eclampsia unless proved otherwise. While most cases of preeclampsia present in the third trimester or within the first 48 hours following delivery, rare cases have been reported prior to 20 weeks gestation or as late as 23 days postpartum. Eclampsia has also been described without prior development of preeclampsia.

Posterior reversible encephalopathy syndrome (PRES) is a transient neuroradiological manifestation characterized by clinical signs and symptoms including hypertension, seizures, and altered mental status, headache, and vision changes. Although this condition is usually transient and completely reversible, ischemic injury and irreversible damage have been reported. Early recognition and management of the underlying cause is essential for complete return of cognitive function. New onset seizure in pregnancy is rare and should be completely evaluated. The differential diagnosis should include Eclampsia, hypoglycemia, drug or alcohol abuse, trauma, embolic disease, brain lesions and arteriovenous malformations.

SOAP 2009