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 wom...

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Bibliographic Details
Published in:Nervenarzt 2003-12, Vol.74 (12), p.1122-1126
Main Authors: Harscher, S, Witte, O W, Möller, U, Bloos, G, Pfleiderer, S O R, Terborg, C
Format: Article
Language:ger
Subjects:
Adult
Cesarean Section
Diagnostic Imaging
Dose-Response Relationship, Drug
Female
Follow-Up Studies
HELLP Syndrome - complications
HELLP Syndrome - diagnosis
HELLP Syndrome - drug therapy
Humans
Infarction, Middle Cerebral Artery - diagnosis
Infarction, Middle Cerebral Artery - drug therapy
Infarction, Middle Cerebral Artery - etiology
Magnesium Sulfate - therapeutic use
Methylprednisolone - therapeutic use
Neurologic Examination - drug effects
Neuropsychological Tests
Nimodipine - therapeutic use
Postoperative Complications - diagnosis
Postoperative Complications - etiology
Pregnancy
Pregnancy Trimester, Third
Puerperal Disorders - diagnosis
Puerperal Disorders - drug therapy
Puerperal Disorders - etiology
Vasospasm, Intracranial - diagnosis
Vasospasm, Intracranial - drug therapy
Vasospasm, Intracranial - etiology
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Summary: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.
ISSN:0028-2804