Neurological Complications of Eclampsia

Objective: Neurological complications contribute significantly to maternal mortality in eclampsia. We studied neurological and obstetric outcome of such patients.Material and Methods: A descriptive study was done at Gynaecology, Neurosurgery and Neurology Units of PGMI Lady Reading Hospital Peshawar, from January 2008 to December 2008. A total of 132 cases of eclampsia were included. Twenty seven cases of eclampsia with neurological complications were studied. We excluded cases with primary neurological abnormalities.Results: During this period one hundred and thirty two patients were admitted with eclampsia. Among 132 cases 27 had neurological abnormalities. One hundred and eight cases were antenatal and twenty four were postnatal. None of them had any antenatal care. Management included initial stabilization followed by early delivery in antenatal cases. Primary anticonvulsant was magnesium sulphate. Phenytoin controlled convulsions in all cases with recurrent seizures. Neurological complications were seen in twenty seven patients. Minor complications like transient impairment of consciousness (97%), blurred vision (22.22%), and Bell’s palsy (07.40%) were observed. Serious neurological complications like CVA (11.11%), recurrent seizures (37.03%) and deep coma occurred in (22.02%) of cases. The cesarean section rate was 18%. Fifty four perinatal deaths and five maternal deaths were recorded. Neurological recovery was complete in all survivors.Conclusion: Critical care backup is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia. High mean arterial pressure and accompanying coagulation defects may be key factors in cerebral pathology. CT scan is a simple and effective investigation in these cases. Phenytoin is an effective second line anticonvulsant. Early delivery prevents worsening of systemic status

Marchiafava-Bignami Disease: A Rare Disease with MRI Findings and Literature Review

Marchiafava bignami disease (MBD) is an unusual complication of chronic alcoholism that typically results in demylination of corpus callosum, but sometimes it can involve the adjacent white matter and even the subcortical and cortical regions. The pathophysiology of MBD is still unknown but thought to be due to vitamin B complex deficiency. Magnetic Resonance Imaging (MRI) is crucial for its diagnosis that shows the characteristic lesions in corpus callosum which may also extend into deep white matter, subcortical and cortical regions. We present a case of Marchiafava bignami disease in 55-year chronic alcoholic referred to us for MRI brain by Medical unit. This case is presented here for its rarity along with its clinical and radiological findings as well as literature review to generate awareness regarding this uncommon toxic complication of chronic alcoholism