AUG 24, 2010
The authors report a case of reversible cerebral edema syndrome with severe brainstem involvement without specific neurological signs in a postpartum eclampsia patient.
The 36-year-old patient suffered from self-limiting generalized tonic-clonic convulsions seven hours after giving birth to a healthy boy at 39 weeks of gestation. She had no history of arterial hypertension or other diseases, her previous pregnancies and deliveries were normal and she took no regular medications. Blood pressure during this pregnancy and before delivery was 12/80 mm Hg. This later rose to 240/100 mm Hg and dropped to 170/80 mm Hg.
A neurological exam five hours after the seizure found no abnormalities. Magnetic resonance imaging (MRI) 11 hours after the seizure showed a T2-hyperintense signal in the whole pons and bilaterally in the rostral basal ganglia, frontal and parietal cortex and subcortex. Posterior white matter was almost completely spared. Diffusion-weighted images were normal. MRI taken after five days showed incomplete regression of the T2-hyperintense areas and at six months was normal.
The authors suggest that moderate interstitial edema caused signal abnormalities seen on MRI without any signs of neuronal dysfunction. They note that extensive brainstem edema did not predict a bad outcome as reported elsewhere. They conclude that acute arterial hypertension and possible endothelial damage in eclampsia can lead to reversible cerebral interstitial edema affecting the brainstem without any specific neurological signs.