Neurocritical care complications of pregnancy and puerperum

Frontera, Jennifer A.; Ahmed, Wamda O

doi:10.1016/j.jcrc.2014.07.010

Cited by 23 publications

(26 citation statements)

References 97 publications

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“…In the context of pregnancy, attention must be given to several peculiar acute neurological emergencies, even considering that most of the following entities are not associated with ALI and coagulopathy and were (almost) never observed in the first trimester of pregnancy. The acute onset of neurological symptoms may evoke stroke, 12 but, in pregnancy, only 10% of strokes occur in the antepartum period, 13 whereas the risk of both ischaemic and haemorrhagic stroke increases in the post-partum period. 14 Still, hypercoagulability associated with pregnancy can be responsible for cerebral venous thrombosis, which is very uncommon in the first trimester, except when underlying hypercoagulability is present, mainly due to factor V Leiden that can also contribute to Budd-Chiari syndrome in the second half of pregnancy.…”

Section: Key Pointmentioning

confidence: 99%

“…No foetal harm has been reported up to 3 Tesla. 13,16 Brain MRI is able to rule out stroke and further able to document the hypersignal of the central grey nucleus on T1-weighted sequences in patients with HE. If spectroscopy is performed, a specific profile of hyperammonaemic encephalopathy can be seen, with an increased glutamine/glutamate peak and decreased peaks of choline and myoinositol 18 (Fig.…”

Section: Key Pointmentioning

confidence: 99%

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Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum

Weiss

Mochel

Rudler

et al. 2018

Journal of Hepatology

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Inborn urea cycle disorders are under-recognised metabolic causes of hyperammonemia in adults. A 28-year-old primigravida, seven weeks pregnant, affected by hyperemesis gravidarum developed acute liver injury (ALI) and then acute liver failure (ALF) in less than 48 h. Because the patient developed atypical features, especially mildly elevated aminotransferases contrasting with very high blood ammonia levels (281 μmol/L), concomitant with normal serum creatinine, an inborn error of metabolism was suspected. We performed emergency metabolic analyses, stopped all protein intake and started with intravenous (i.v.) high caloric intake, nitrogen scavenger drugs and haemodialysis. The neurological and hepatic status of the patient quickly improved together with normalisation of her ammonemia levels. High plasma glutamine and urinary orotic acid, alongside low plasma arginine, citrulline and ornithine were suggestive of an ornithine transcarbamylase deficiency, later confirmed by molecular analyses. Foetal sex was female, as determined by foetal DNA analysis in maternal blood, and foetal development was unremarkable throughout the pregnancy. Delivery was induced at 39 weeks with a close monitoring of ammonemia levels and i.v. perfusion of carbohydrates and lipids during labour and immediately post-partum to avoid hypercatabolism. Delivery was uneventful and the patient delivered a healthy female baby. Urea cycle disorders should be contemplated in non-jaundiced patients with ALI or ALF, severe hyperammonemia and normal serum creatinine regardless of serum aminotransferase levels. The prompt recognition of this rare condition and the rapid initiation of adequate metabolic therapy are mandatory to prevent irreversible neurological sequelae and to avoid liver transplantation.

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Section: Key Pointmentioning

confidence: 99%

Section: Key Pointmentioning

confidence: 99%

Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum

Weiss

Mochel

Rudler

et al. 2018

Journal of Hepatology

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“…A magzati halálozási arány körülbelül 12% [3]. A rekurrens ischaemiás stroke kockázata alacsony, 1 évre 1%, 5 évre 2% [33].…”

Section: Prognózisunclassified

Terhesség és akut ischaemiás stroke

Bereczki

2016

Orvosi Hetilap

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A graviditás alatt jelentkező ischaemiás stroke jelentős tényezője mind az anyai, mind a magzati morbiditásnak és mortalitásnak. A terhesség és gyermekágy során észlelt nagyobb kockázatot egyfelől a graviditással összefüggő haemostaseologiai és hemodinamikai változások, másfelől különböző, a terhességre specifikus és nem specifikus kocká-zati faktorok eredményezik. A diagnosztika, akut terápia és prevenció területén fontos kérdés a beavatkozások esetleges magzatkárosító veszélye. Multicentrikus regiszter létrehozása mindenképpen kívánatos volna a terhességi stroke alaposabb megismeréséhez. Tekintettel arra, hogy nagy esetszámú, randomizált, kontrollált vizsgálatok és ezekre alapozott definitív irányelvek nem állnak rendelkezésre, a terhesség alatt jelentkező akut stroke során minden esetben szakértők bevonásával és a haszon-kockázat megfelelő értékelésével kell egyénre szabott döntést hozni. Orv. Hetil., 2016, 157(20), 763-766. Kulcsszavak: terhesség, stroke, ischaemiás stroke Pregnancy and acute ischemic strokePregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits. Rövidítések CT = komputertomográfia; DWI = diffusion-weighted imaging; LMWH = low molecular weight heparin; MRI = mágne-sesrezonancia-vizsgálat; rtPA = rekombináns humán szöveti plazminogén aktivátor; TOF = time-of-flight; UFH = unfractionated heparin Ischaemiás stroke-ról beszélünk, ha a neurológiai funkció zavar hátterében fokális agyi, gerincvelői vagy retinalis infarktus áll [1]. A terhesség alatt jelentkező agyi érka-tasztrófa ugyan ritka esemény, mégis az egyébként alacsony rizikójú fiatal populációban bekövetkező strokeok 12-35%-áért és az anyai mortalitás 12%-áért felelős [2,3]. A gesztáció során a legnagyobb kockázatot a szü-lés körüli és gyermekágyi időszak jelenti [4]. Az ischaemiás stroke-ok 100 000 szülésre vonatkoztatott gyakorisága 4,3 és 210 közötti [5], azonban a szülési átlagéletkor elmúlt három évtizedben 24,6 évről 27,2 évre történő növekedésével [6] -és ezzel párhuzamosan a társuló cardiovascularis rizikófaktorok gyarapodásával [7] -össz-hangban emelkedő tendenciát mutat: az Amerikai Egyesült Államokban 1994 és 2007 között az antenatalis és post partum stroke miatti hospitalizációk 47%-kal, illetve 83%-kal nőttek [8]. Patogenezis és kockázati tényezőkA terhesség során észlelt emelkedett stroke-kockázathoz több tényező is hozzájárul. Ezek egyfelől a graviditással ÖSSZEFOGLALÓ KÖZLEMÉNY

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“…Preeclampsia is a multisystem disorder accompanied by the new onset of hypertension and end-organ dysfunction with or without proteinuria. The critical conditions of hypertensive pregnancy disorders include eclampsia, hemolysis, elevated liver enzymes, low platelet counts, and disseminated intravascular coagulopathy [6][7][8][9]. Hypertensive pregnancy disorders are critical risk factors for pregnancy-associated stroke [10].…”

Section: Introductionmentioning

confidence: 99%

Association between hypertensive pregnancy disorders and future risk of stroke in Taiwan: a Nationwide population-based retrospective case-control study

Huang¹,

Huang

Lin

et al. 2020

BMC Pregnancy Childbirth

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Background: The incidence of female stroke has increased gradually and has begun occurring at a younger age in recent years. Given that women live longer than men, stroke would cause more negative and longer-term impacts on the rest of the lives of women. There are few related studies on Asian women. We aimed to evaluate stroke risk in Asian women following hypertensive pregnancy disorders. Methods: Using the Taiwan National Health Insurance database, we designed a retrospective study that included pregnant women between 2000 and 2013. We selected an age-matched control group of women without hypertensive pregnancy disorders at a 1:3 ratio. The endpoint was any episode of stroke; otherwise, the patients were tracked until December 31, 2013. After the index date until the end of 2013, Cox proportional hazards analysis was used to compare the risk of incident stroke. The risk factors for stroke were determined using Cox proportional regression to calculate the hazard ratio (HR) compared with the control group. Results: During the follow-up period, the Kaplan-Meier analysis indicated that patients with hypertensive pregnancy disorders had a significantly higher risk of developing stroke than did patients without hypertensive pregnancy disorders (log-rank test P < 0.001). Multivariate Cox regression analysis demonstrated that the case group had a 2.134fold increased risk of stroke (HR = 2.134; 95% CI = 1.817-2.505; P < 0.001). Conclusion:Our study provided evidence of an increased risk of stroke in patients with hypertensive pregnancy disorders. Compared with those without such disorders, the patients who had experienced the disorders had a 2.134fold (P < 0.001) higher risk of developing stroke in the future.

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Neurocritical care complications of pregnancy and puerperum

Cited by 23 publications

References 97 publications

Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum

Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum

Terhesség és akut ischaemiás stroke

Association between hypertensive pregnancy disorders and future risk of stroke in Taiwan: a Nationwide population-based retrospective case-control study

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