[Cerebral vasospasms with hemodynamic infarctions as a complication of HELLP syndrome].
Sinal thrombosis, intracerebral bleeding, cerebral edema, and cerebral vasospasm are typical neurological complications in pre- and eclampsia. Hemolysis, elevated liver enzyme, and low platelet (HELLP) syndrome is a rare, severe complication of pre-eclampsia. We present the case of a 33-year-old woman with HELLP syndrome. After a cesarean section, generalized epileptic seizure occurred and intubation was necessary due to sustained unconsciousness. Despite magnesium therapy, bilateral hemodynamic ischemic infarctions and narrowing of the circle of Willis were visible on MRI, and vasospasm of all large basal cerebral arteries was confirmed by cerebral angiography and transcranial Doppler sonography. During the following 2 weeks, the cerebral vasospasm resolved with application of high-dose methyl prednisolone and nimodipine. After extubation, the patient initially suffered from mild psychosyndrome and ataxia but recovered completely after 3 months. The HELLP syndrome may be complicated by cerebral vasospasm with subsequent hemodynamic strokes. Combined treatment with magnesium, corticosteroids, and nimodipine can be recommended. In our case, this regimen led to resolution of the cerebral vasospasm and complete clinical recovery.
Harscher
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Klinik für Neurologie, Friedrich-Schiller-Universität Jena. Stefan.Harscher@med.uni-jena.de
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Pfleiderer
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D000328:Adult; D002585:Cesarean Section; D003952:Diagnostic Imaging; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D017359:HELLP Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D009460:Neurologic Examination / Q000187:drug effects; D009483:Neuropsychological Tests; D009553:Nimodipine / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011644:Puerperal Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D009553:Nimodipine; D008278:Magnesium Sulfate; D008775:Methylprednisolone