[Eclampsia and total bilateral amaurosis in a woman subsequently diagnosed with reversible posterior leukoencephalopathy syndrome].
Eclampsia is a complication of preeclampsia and is characterized by the appearance of grand mal seizures and/or coma, in the absence of any other neurological abnormalities. Neither focal neurological deficit nor prolonged coma tends to develop following a crisis. Eclampsia should therefore lead us to consider other clinical entities that may require special treatment. We report the case of a pregnant woman who presented total bilateral loss of vision following a grand mal seizure. The patient was subsequently diagnosed with reversible posterior leukoencephalopathy syndrome, which has clinical and radiologic manifestations linked to several causes, such as hypertensive encephalopathy, eclampsia, kidney failure, and immunosuppressant therapy. The syndrome involves headache, altered states of consciousness, changes in vision (including blindness), and seizures; these symptoms generally coincide with a rapid increase in blood pressure. Diagnosis requires neuroimaging, and the typical finding is edema in the posterior zones of the brain hemispheres. The most widely accepted hypothesis concerning the pathophysiologic mechanism underlying this syndrome is failure of cerebral autoregulation with development of vasogenic edema. The prognosis is good and the alterations usually resolve completely with appropriate treatment, which is the same as for the management of eclampsia, with strict monitoring of blood pressure.
Andrés
M A Arteche
MA
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital García Orcoyen, Estella, Navarra. aartetxa@cfnavarra.es
Ortiz-Gómez
J R
JR
Mansob
A M Martín
AM
Martí
I Plaja
IP
García
S Hernández
SH
Ortigosa
F Sos
FS
D000293:Adolescent; D001766:Blindness / Q000209:etiology; D004461:Eclampsia / Q000209:etiology; D005260:Female; D006801:Humans; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000175:diagnosis*; D011247:Pregnancy