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      • Record: found
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      Complete recovery after antepartum massive intracerebral hemorrhage in an atypical case of sudden eclampsia

      case-report

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          Abstract

          Background:

          Intracerebral hemorrhage is an infrequent but severe complication in pregnant women with hypertension.

          Case Description:

          We describe an atypical case of a patient with no risk factors who developed sudden eclampsia and spontaneous intracerebral hemorrhage during the 34 th week of pregnancy. She underwent successful emergent Cesarean section followed by craniotomy. Both intraoperative surveillance and postoperative magnetic resonance angiographic examination of the cerebral vessels failed to identify an aneurysm, arteriovenous malformation, tumor, or leptomeningeal disease.

          Conclusion:

          We discuss the management of this case and review the literature regarding the threshold for which initiation of antihypertensive treatment is indicated in pregnant patients.

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          Most cited references34

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          Magnesium gates glutamate-activated channels in mouse central neurones.

          Kristine Nowak, P Bregestovski, P Ascher … (2015)
          The responses of vertebrate neurones to glutamate involve at least three receptor types. One of these, the NMDA receptor (so called because of its specific activation by N-methyl-D-aspartate), induces responses presenting a peculiar voltage sensitivity. Above resting potential, the current induced by a given dose of glutamate (or NMDA) increases when the cell is depolarized. This is contrary to what is observed at classical excitatory synapses, and recalls the properties of 'regenerative' systems like the Na+ conductance of the action potential. Indeed, recent studies of L-glutamate, L-aspartate and NMDA-induced currents have indicated that the current-voltage (I-V) relationship can show a region of 'negative conductance' and that the application of these agonists can lead to a regenerative depolarization. Furthermore, the NMDA response is greatly potentiated by reducing the extracellular Mg2+ concentration [( Mg2+]o) below the physiological level (approximately 1 mM). By analysing the responses of mouse central neurones to glutamate using the patch-clamp technique, we have now found a link between voltage sensitivity and Mg2+ sensitivity. In Mg2+-free solutions, L-glutamate, L-aspartate and NMDA open cation channels, the properties of which are voltage independent. In the presence of Mg2+, the single-channel currents measured at resting potential are chopped in bursts and the probability of opening of the channels is reduced. Both effects increase steeply with hyperpolarization, thereby accounting for the negative slope of the I-V relationship of the glutamate response. Thus, the voltage dependence of the NMDA receptor-linked conductance appears to be a consequence of the voltage dependence of the Mg2+ block and its interpretation does not require the implication of an intramembrane voltage-dependent 'gate'.
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            Pregnancy-related mortality from preeclampsia and eclampsia.

            Allison MacKay, Hani K. Atrash, Lise Berg (2001)
            To examine the role of preeclampsia and eclampsia in pregnancy-related mortality. We used data from the Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System to examine pregnancy-related deaths from preeclampsia and eclampsia from 1979 to 1992. The pregnancy-related mortality ratio for preeclampsia-eclampsia was defined as the number of deaths from preeclampsia and eclampsia per 100,000 live births. Case-fatality rates for 1988-1992 were calculated for preeclampsia and eclampsia deaths per 10,000 cases during the delivery hospitalization, using the National Hospital Discharge Survey. Of 4024 pregnancy-related deaths at 20 weeks' or more gestation in 1979-1992, 790 were due to preeclampsia or eclampsia (1.5 deaths/100,000 live births). Mortality from preeclampsia and eclampsia increased with increasing maternal age. The highest risk of death was at gestational age 20-28 weeks and after the first live birth. Black women were 3.1 times more likely to die from preeclampsia or eclampsia as white women. Women who had received no prenatal care had a higher risk of death from preeclampsia or eclampsia than women who had received any level of prenatal care. The overall preeclampsia-eclampsia case-fatality rate was 6.4 per 10,000 cases at delivery, and was twice as high for black women as for white women. The continuing racial disparity in mortality from preeclampsia and eclampsia emphasizes the need to identify those differences that contribute to excess mortality among black women, and to develop specific interventions to reduce mortality from preeclampsia and eclampsia among all women.
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              Voltage-dependent block by Mg2+ of NMDA responses in spinal cord neurones.

              M L Mayer, G L Westbrook, P Guthrie (2015)
              Acidic amino acids are putative excitatory synaptic transmitters, the ionic mechanism of which is not well understood. Recent studies with selective agonists and antagonists suggest that neurones of the mammalian central nervous system possess several different receptors for acidic amino acids, which in turn are coupled to separate conductance mechanisms. N-methyl-D-aspartic acid (NMDA) is a selective agonist for one of these receptors. The excitatory action of amino acids acting at NMDA receptors is remarkably sensitive to the membrane potential and it has been suggested that the NMDA receptor is coupled to a voltage-sensitive conductance. Recently, patch-clamp experiments have shown the voltage-dependent block by Mg2+ of current flow through ion channels activated by L-glutamate. We now show using voltage-clamp experiments on mouse spinal cord neurones that the voltage-sensitivity of NMDA action is greatly reduced on the withdrawal of physiological concentrations (approximately 1 mM) of Mg2+ from the extracellular fluid. This provides further evidence that Mg2+ blocks inward current flow through ion channels linked to NMDA receptors.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Journal ID (publisher-id): SNI
                Title: Surgical Neurology International
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2012
                Publication date (Electronic): 19 June 2012
                Volume: 3
                Electronic Location Identifier: 65
                Affiliations
                [1 ]Ghaly Neurosurgical Associates, Aurora, IL, USA
                [2 ]Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
                [3 ]Department of Anesthesiology, John Stroger Cook County Hospital, Chicago, IL, USA
                [4 ]Department of Anesthesiology, University of Illinois, Chicago, IL, USA
                Author notes
                [* ]Corresponding author
                Article
                Publisher ID: SNI-3-65
                DOI: 10.4103/2152-7806.97167
                PMC ID: 3385067
                PubMed ID: 22754730
                SO-VID: 1e081d33-6f8a-4225-9d58-44faabb0d415
                Copyright © Copyright: © 2012 Ghaly RF.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 05 February 2012
                Date accepted : 08 February 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: pregnancy,intracerebral hemorrhage,eclampsia
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: pregnancy, intracerebral hemorrhage, eclampsia

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