title: Neuromyelitis optica in pregnancy complicated by posterior reversible encephalopathy syndrome, eclampsia and fetal death.
abstract: Neuromyelitis optica (NMO) is a demyelinating syndrome characterized by optic neuritis and acute myelitis with poor recovery and a progressive course. We report a poor outcome complicated by posterior reversible encephalopathy syndrome (PRES) and eclampsia and review available literature and current evidence for anticipation of adverse fetal and maternal effects. After a pregnancy complicated by multiple admissions for painful NMO exacerbations, a primiparous patient with seropositive NMO presented at 31 + 3/7 weeks with eclampsia, HELLP and subsequent fetal death. MRI confirmed PRES. NMO may be associated with eclampsia and leads to adverse maternal and fetal outcomes. Posited mechanisms include antibody-mediated placental damage and a heightened risk of eclampsia-associated PRES. Further characterization of the course of NMO and its relationship with pregnancy outcomes in larger series would be invaluable.
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Igel
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Garretto
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Robbins
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Swerdlow
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Judge
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Dayal
keywords: Aquaporin 4; Devic’s disease; Eclampsia; Neuromyelitis optica; Posterior reversible encephalopathy syndrome