Zusammenfassung
Neurologische Komplikationen bei Prä- und Eklampsie umfassen Sinusthrombose, intrazerebrale Blutungen, zerebrale Ödeme sowie intrakranielle Vasospasmen. Das HELLP (hemolysis, elevated liver enzymes, low platelet)-Syndrom ist eine schwere Form der Eklampsie. Wir berichten über eine 33-jährige Patientin, die nach einer Sectio caesarea einen Grand-mal-Anfall erlitt und auf Grund einer progredienten Bewusstseinstrübung intubationspflichtig wurde. Kernspintomographisch zeigten sich trotz Magnesiumgabe bilaterale hämodynamische Infarkte sowie eine ausgeprägte Engstellung aller basalen Hirnarterien. In der transkraniellen Dopplersonographie und der digitalen Subtraktionsangiographie ergaben sich Vasospasmen aller intrazerebralen Gefäße. Erst unter einer Therapie mit hochdosiertem Methlyprednisolon und Nimodipin waren die Vasospasmen rückläufig. Zunächst bestand ein mittelschweres Psychosyndrom und eine Gangunsicherheit; 3 Monate später hatte sich die Patientin ohne bleibende Defizite erholt.
Zerebrale Vasospasmen können beim HELLP-Syndrom zu ausgeprägten hämodynamischen Infarkten führen. Therapeutisch sollte daher Magnesium, Kortikosteroide und Nimodipin gegeben werden, was bei unserer Patientin zu einem Rückgang der Vasospasmen führte.
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.
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Literatur
Chalela JA et al. (2001) Continuous arterial spin labeling perfusion magnetic resonance imaging findings in postpartum vasculopathy. J Neuroimaging 11(4): 444–6
D'Anna R (1996) The HELLP syndrome. Notes on its pathogenesis and treatment. Minerva Ginecol 48(4): 147–54
Dittmar G (1999) Neurological spectrum of pre-eclampsia and eclampsia. Nervenarzt 70(12): 1098–103
Dürig P (1997) Schwere Komplikationen der hypertensiven Schwangerschaftserkrankungen Eklampsie, HELLP-Syndrom, akute Fettleber. Gynäkologe 30(9): 702–711
Fitzgerald DJ et al. (1987) Decreased prostacyclin biosynthesis preceding the clinical manifestation of pregnancy-induced hypertension. Circulation 75(5): 956–63
Geocadin RG et al. (2002) Intracerebral hemorrhage and postpartum cerebral vasculopathy. J Neurol Sci 205(1): 29–34
Gliemroth J et al. (2000) HELLP syndrome with haemaglobin vasospasm. J Clin Neurosci 7(1): 59–62
Hansen WF et al. (1996) Transcranial Doppler findings of cerebral vasospasm in preeclampsia. J Matern Fetal Med 5(4): 194–200
Harms K et al. (1995) Maternal hemolysis, elevated liver enzymes, low platelet count, and neonatal outcome. Am J Perinatol 12(1): 1–6
Ito T et al. (1995) MR angiography of cerebral vasospasm in preeclampsia. Am J Neuroradiol 16(6): 1344–6
Kanayama N et al. (1993) Magnetic resonance imaging angiography in a case of eclampsia. Gynecol Obstet Invest 36(1): 56–8
Lewis L.K et al. (1988) CT and angiographic correlation of severe neurological disease in toxemia of pregnancy. Neuroradiology 30(1): 59–64
Lindheimer MD, Katz AI (1989) Preeclampsia: pathophysiology, diagnosis, and management. Annu Rev Med 40: 233–50
Magann EF et al. (1994) Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 171(4): 1154–8
Martin JN Jr et al. (1990) Plasma exchange for preeclampsia. I. Postpartum use for persistently severe preeclampsia-eclampsia with HELLP syndrome. Am J Obstet Gynecol 162(1): 126–37
Mushambi MC, Halligan AW, Williamson K (1996) Recent developments in the pathophysiology and management of pre-eclampsia. Br J Anaesth 76(1): 133–48
Rath W, Loos W, Kuhn W (1994) HELLP syndrome. Zentralbl Gynäkol 116(4): 195–201
Sibai BM,Kustermann L, Velasco J (1994) Current understanding of severe preeclampsia, pregnancy-associated hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, hemolysis, elevated liver enzymes, and low platelet syndrome, and postpartum acute renal failure: different clinical syndromes or just different names? Curr Opin Nephrol Hypertens 3(4): 436–45
Sibai BM et al. (1993) Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 169(4): 1000–6
Trommer BL, Homer D, Mikhael MA (1988) Cerebral vasospasm and eclampsia. Stroke 19(3): 326–9
Ursell MR et al. (1998) Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: implications for management. Stroke 29(9): 1995–8
Visser W, Wallenburg HC (1995) Temporising management of severe pre-eclampsia with and without the HELLP syndrome. Br J Obstet Gynaecol 102(2): 111–7
Walsh SW (1985) Preeclampsia: an imbalance in placental prostacyclin and thromboxane production. Am J Obstet Gynecol 152(3): 335–40
Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142(2): 159–67
Will AD et al. (1987) Cerebral vasoconstriction in toxemia. Neurology 37(9): 1555–7
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Harscher, S., Witte, O.W., Möller, U. et al. Zerebrale Vasospasmen mit hämodynamischen Infarkten als Komplikation eines HELLP-Syndroms. Nervenarzt 74, 1122–1126 (2003). https://doi.org/10.1007/s00115-003-1581-7
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DOI: https://doi.org/10.1007/s00115-003-1581-7