Eclampsia/postpartum angiopathyepilepsyCerebrovascular accidents

Hemorrhage

Ruptured aneurysm or malformation

Arterial embolism or thrombosis

Cerebral venous thrombosis

Hypoxic ischemic encephalopathy

Angiomas

Eclampsia/postpartum angiopathy

Congenital brain defects

Infectious encephalitis: bacterial, viral, parasitic, tuberculosis

Trauma

Brain tumors: benign, neoplastic

Primary

Metastatic

Liver/renal failure

Metabolic derangement: hypoglycemia, hyponatremia, hyperosmolar states (hyperosmolar nonketotic hyperglycemia), and hypocalcaemia

Drug overdose/withdrawal

Thrombophilia: antiphospholipid syndrome

Autoimmune disorders

Systemic lupus erythematosus

Thrombotic thrombocytopenic

Table 1. Potential causes of seizures in pregnancy and postpartum.

EclampsiaIn the Western world, incidence of eclampsia has

decreased over the last 10 years and now ranges from 4 to 5 in 10,000 pregnancies.

the World Health Organization reports an increase, 0.1% to 0.8%, in developing countries

The incidence is higher in tertiary referral centers, in multifetal gestation, and in populations with no prenatal care.

Eclampsia is defined as the development of convulsions and/or unexplained coma during pregnancy or postpartum in patients with signs and symptoms of preeclampsia

Hypertension is considered to be the hallmark for the diagnosis of eclampsia

The hypertension can be severe in 20–54% of cases mild in 30–60% of cases. absent in 16%

Several clinical symptoms may occur before or after the onset of convulsionpersistent occipital or frontal headaches, blurred vision, photophobia, epigastric and/or right upper-quadrant pain, and altered mental status

The diagnosis of eclampsia is usually associated with proteinuria

proteinuria (≥ 3+ on dipstick) was present in only 48% of the cases, proteinuria was absent in 14% of the cases

The onset of eclamptic convulsions antepartum, intrapartum, or postpartum.antepartum convulsions 38% to 53%.

postpartum eclampsia 11% to 44%.The cases of eclampsia that occur after 48 h postpartum, but less than 4 weeks after delivery, are defined as late postpartum eclampsia

56%of these women will demonstrate a clinical picture of preeclampsia during labor or immediately postpartum others(34%) will demonstrate these clinical findings for the first time more than 48 h after delivery

Cerebral imaging is indicated for patients with focal neurologic deficits prolonged coma.atypical presentation for eclampsia onset before 20 weeks of gestation or more than 48 h after delivery eclampsia refractory to adequate magnesium sulfate therapy.

Occurs in .5-1% womenOne of the leading cause s indirect mathernal

death

The major pregnancy related risksincreased seizure rates with mortality and fetal malformationsCauses:Nausea and vomitingAntacid usePregnancy hypervolemiaIncreased glomerular clearanceDiscontinued medicationSleep deprivation

Pre pregnancy manangmentSeizure should be well controlled on the least

number of AEDs and the lowest possible doseSodium valporate should be change

Antenatal managementWomen on AEDs shoud commence folic acid

5 mg dailyMay need to increase dose Vit K prescribe from 36 weeks of gestation

Incidence of stroke in pregnancy 1.5- 71 /100000pregnancyAlmost 9% of pregnancy related mortality

rate1/3 associated with PIH10%developed antepartum40%developed intrapartum50%developed postpartum

Risk factorsOlder ageMigraineHypertension obesityCardiac diseaseSmoking GDMC/S Obstetric hemorrhage

The most common risk factors Pregnancy associated hypertensive

disorders(3-8)C/s (1.5 fold)

Vascular thrombosis and embolism are subdivided into two categories: arterial and venous.

Cerebral hemorrhage is also subdivided into intracerebral and subarachnoid hemorrhage.112

Preeclampsia syndromSub cortical peri-vascular edema and

petechial hemorrage

Cerebral embolismMore common during the latter half of

pregnancy and early puerperiumDiagnosisExclude thrombosis and hemorrhage and

identify embolic source

Cerebral venous thrombosis

The prevalence of this phenomenon is estimated to be 1–2 per 10,000 to 40–50 per 10,000 childbirths.

more common in the puerperium than during pregnancy, with more than 75% of total cases presenting postpartum

Headaches (severe, diffuse, constant, and progressing in intensity) and seizures are common presenting symptoms, but most patients are not hypertensive

1/3 of patient have convulsionDiagnosise with MR venograghy

Hemorrhagic strokeIntra-cerebral stroke : bleeding into the

brain parenchymaOften associated with chronic hypertension

/superimposed preeclampsia

Subarachnoid hemorrhageBleeding from A-V malformation and

aneursmysms