title: [Epidural analgesia is not the only cause of peripartum central neurologic symptoms. Report of one case of posterior reversible encephalopathy syndrome].
abstract: A young woman without any significant medical history received an epidural analgesia for labour. She suddenly presented headache, vision loss, nausea and arterial hypertension a few minutes after a 4-ml ropivacaine 0.75% bolus. The catheter was withdrawn and symptoms completely disappeared within 15 minutes. A new epidural catheter was inserted. Thereafter, the patient gave birth to a healthy newborn infant. Half an hour later, while the epidural catheter was still infusing, she presented generalized tonicoclonic seizure. Potential diagnoses were systemic toxicity of local anaesthetics and eclampsia. Accordingly, the patient received intravenous lipid emulsion and magnesium sulphate. There was no biological abnomabilities. A final diagnosis of posterior reversible encephalopathy syndrome was made with MRI showing bilateral hyperintensity areas involving the cortex of the occipital and frontal areas asymmetrically. On the sixth day, after delivery, the patient was discharged seizure-free. Repeated MRI 4 weeks after discharge was unremarkable.
authors.affiliation: Département d'anesthésie-douleur, GHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 09, France. beren2000@hotmail.com
authors.forename: B
authors.initials: B
authors.lastname: Etesse
authors.forename: V
authors.initials: V
authors.lastname: Letouzey
authors.forename: C
authors.initials: C
authors.lastname: Roger
authors.forename: A
authors.initials: A
authors.lastname: Lefauconnier
authors.forename: J
authors.initials: J
authors.lastname: Ripart
mesh_terms: D000577:Amides / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects; D001766:Blindness / Q000209:etiology; D001921:Brain / Q000473:pathology; D004461:Eclampsia / Q000503:physiopathology; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D009325:Nausea / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology*; D058725:Peripartum Period; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology*; D011247:Pregnancy; D000077212:Ropivacaine; D012640:Seizures / Q000139:chemically induced; D015149:Tocolytic Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D015149:Tocolytic Agents; D008278:Magnesium Sulfate; D000077212:Ropivacaine